1
|
Alfvén T, Bennet R, Granath A, Dennison SH, Eriksson M. The pneumococcal conjugate vaccine had a sustained effect on Swedish children 8 years after its introduction. Acta Paediatr 2024; 113:764-770. [PMID: 38217260 DOI: 10.1111/apa.17108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 01/02/2024] [Accepted: 01/04/2024] [Indexed: 01/15/2024]
Abstract
AIM The pneumococcal conjugate vaccine, which covered seven serotypes of Streptococcus pneumoniae (PCV7), was introduced in Stockholm, Sweden, in 2007. It was replaced by a 13-valent vaccine (PCV13) in 2011. We previously reported a decreased incidence of pneumonia and sinusitis among young children 4 years after the introduction of the PCV7. This study followed the incidence of pneumonia, sinusitis, mastoiditis and meningitis for four more years. METHODS We studied validated hospital registry data covering children up to 17 years of age, who were hospitalised in the Stockholm region from 2003 to 2016, when the child population peaked at 485 687. All 11 115 cases diagnosed with pneumonia, coded as bacterial pneumonia, sinusitis, mastoiditis, bacterial meningitis or empyema, were identified. The controls had viral pneumonia or pyelonephritis. RESULTS The incidence rates for children under 2 years of age hospitalised for sinusitis, mastoiditis and meningitis decreased significantly by 61%-79% during the eight-year post-vaccination period. Hospitalisations for bacterial pneumonia decreased by 19%-25% in the same age group. These changes were probably due to both the vaccines and changes in diagnosis routines. CONCLUSION The effect of vaccination on children under 2 years of age was sustained 8 years after the introduction of the pneumococcal conjugate vaccines.
Collapse
Affiliation(s)
- Tobias Alfvén
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Sachs' Children and Youth Hospital, South General Hospital, Stockholm, Sweden
| | - Rutger Bennet
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Anna Granath
- Department of Clinical Sciences, Intervention and Technology, Division of ENT Diseases, Karolinska Institutet, Stockholm, Sweden
- Department of ENT Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Sofia Hultman Dennison
- Department of Clinical Sciences, Intervention and Technology, Division of ENT Diseases, Karolinska Institutet, Stockholm, Sweden
| | - Margareta Eriksson
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| |
Collapse
|
2
|
Yanai T, Yoshida S, Takeuchi M, Kawakami K. Pneumonia hospitalization after introduction of pneumococcal conjugate vaccine in Japan: Descriptive study using a nationwide claims database. Vaccine 2023:S0264-410X(23)00626-6. [PMID: 37286407 DOI: 10.1016/j.vaccine.2023.05.065] [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: 03/17/2023] [Revised: 05/16/2023] [Accepted: 05/26/2023] [Indexed: 06/09/2023]
Abstract
BACKGROUND The pneumococcal conjugate vaccine (PCV) was introduced to children in Japan in February 2010 for PCV7 and February 2013 for PCV13. This study aimed to investigate the changes in child pneumonia hospitalization in Japan, before and after the introduction of PCV. METHODS We utilized the JMDC Claims Database, an insurance claims database in Japan, with a cumulative population of approximately 10.6 million as of 2022. We extracted data of approximately 3.16 million children below 15 years of age from January 2006 to December 2019, and evaluated the number of pneumonia hospitalizations per 1,000 persons per year. The primary analysis was a comparison of three categories according to PCVs: before PCV7, before PCV13, and after PCV13 (2006-2009, 2010-2012, and 2013-2019). The secondary analysis was an interrupted time series (ITS) analysis, assessing the slope change in pneumonia hospitalizations per month, with PCV introduction as an intervening factor. RESULTS The cases of pneumonia hospitalizations during the study period was 19,920 (0.6 %); 25 % of these were 0-1 years, 48 % were 2-4 years, 18 % were 5-9 years, and 9 % were 10-14 years. Pneumonia hospitalizations per 1000 population was 6.10 before PCV7 and 4.03 after PCV13, representing a 34 % decrease (p < 0.001). The reduction by age group was -30.1 % in 0-1 years, -20.3 % in 2-4 years, -41.7 % in 5-9 years, and -52.9 % in 10-14 years, significant reduction in all groups. ITS analysis showed a further reduction of -0.17 % per month after the introduction of PCV13 than that before PCV7 (p = 0.006). CONCLUSION Our study estimated 4-6 pneumonia hospitalizations per 1000 pediatric population in Japan, with a 34 % decrease after the introduction of PCV. This study examined the nationwide effectiveness of PCV, further studies are needed in all age groups.
Collapse
Affiliation(s)
- Takanori Yanai
- Department of Pharmacoepidemiology, Kyoto University Graduate School of Medicine and Public Health, Kyoto, Japan
| | - Satomi Yoshida
- Department of Pharmacoepidemiology, Kyoto University Graduate School of Medicine and Public Health, Kyoto, Japan
| | - Masato Takeuchi
- Department of Pharmacoepidemiology, Kyoto University Graduate School of Medicine and Public Health, Kyoto, Japan
| | - Koji Kawakami
- Department of Pharmacoepidemiology, Kyoto University Graduate School of Medicine and Public Health, Kyoto, Japan.
| |
Collapse
|
3
|
Boiko NV, Stagnieva IV, Gukasyan EL, Stateshnaya PA. [Children's rhinosinusitis orbital complications]. Vestn Otorinolaringol 2023; 88:74-79. [PMID: 37184558 DOI: 10.17116/otorino20228802174] [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: 05/16/2023]
Abstract
The number of cases of children's sinogenic orbital complications does not reduce in spite of the advanced methods of paranasal sinuses visualization, wide use of antibacterial therapy against sinusitis, and preventive vaccination against pneumococcal disease. Orbital complications are more common with children than with adults, the basic reason of their development being ethmoiditis. The prevailing classification of orbital complications proposed by J. Chandler et al. divides these into preceptal and postceptal forms and gives description to 5 development stages of orbital complications in the order of their increasing severity. At an early age preceptal and orbital cellulites prevail, and these commonly need conservative treatment only. In case of orbital cellulitis, the major treatment method is endovenous antibiotic therapy in which the chosen antibiotic is to cover the whole spectrum of aerobic and anaerobic microbes often extracted in such cases. At small subperiostal abscesses (<0.5-1 ml), conservative treatment during 24-48 hours is possible. If there is no positive dynamics, or abscess grows in size, or eye symptoms progress, abscess and affected sinuses drain is recommended. Orbital abscess is to be given surgical treatment; at the same time endoscopic management of paranasal sinuses might by complemented with external surgical approaches (lateral and medial orbitotomy).
Collapse
Affiliation(s)
- N V Boiko
- Rostov State Medical University, Rostov-on-Don, Russia
| | - I V Stagnieva
- Rostov State Medical University, Rostov-on-Don, Russia
| | - E L Gukasyan
- Rostov State Medical University, Rostov-on-Don, Russia
| | | |
Collapse
|
4
|
Korppi M, Palmu S, Heikkilä P, Csonka P. Antibiotic prescriptions for child sinusitis varied between specialties after Finnish guidelines were updated in 2018. Acta Paediatr 2022; 112:1041-1048. [PMID: 36562286 DOI: 10.1111/apa.16641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 12/14/2022] [Accepted: 12/21/2022] [Indexed: 12/24/2022]
Abstract
AIM We evaluated antibiotic prescriptions issued for Finnish children with acute sinusitis by a nationwide private outpatient clinic network from 2014-2020. Data were compared before and after updated guidelines in 2018. METHODS The study comprised data on 45 296 children aged 2-17 years with acute sinusitis, namely diagnoses, ages, dates, the doctor's specialty and any antibiotics. We measured compliance with the updated 2018 Finnish guidelines, which recommended amoxicillin or amoxicillin-clavulanic acid for children under 12 years old, with doxycycline as an alternative for 12 years plus. RESULTS There were 6621-7585 visits per year for acute sinusitis in 2014-2019 and 2954 in 2020. Antibiotics were prescribed for 37.9%-41.6% of patients during the study years. Amoxicillin, including penicillin, accounted for 35.9% of prescriptions, followed by amoxicillin-clavulanic acid (26.9%). Macrolides accounted for 20.6% and, encouragingly, decreased by 38% from 2014-2019. Doxycycline accounted for 5.3%. Paediatricians, general practitioners (GPs) and ear, nose and throat specialists followed the guidelines in 75.1%, 73.8% and 66.7% of cases, respectively. GPs prescribed antibiotics more often than other physicians. CONCLUSION Antibiotics were prescribed for about 40% of acute sinusitis visits by Finnish children from 2014-2019. Specialities differed with regard to prescribing rates and whether they followed the guidelines.
Collapse
Affiliation(s)
- Matti Korppi
- Centre for Child, Adolescent, and Maternal Health Research, Tampere University Hospital and Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland
| | - Sauli Palmu
- Centre for Child, Adolescent, and Maternal Health Research, Tampere University Hospital and Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland
| | - Paula Heikkilä
- Centre for Child, Adolescent, and Maternal Health Research, Tampere University Hospital and Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland
| | - Péter Csonka
- Centre for Child, Adolescent, and Maternal Health Research, Tampere University Hospital and Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland.,Terveystalo Healthcare, Tampere, Finland
| |
Collapse
|
5
|
Sisk CD, Wright AT, Warrier R. Monocular Vision Loss Subsequent to Complicated Orbital Cellulitis. Clin Pediatr (Phila) 2022; 61:384-386. [PMID: 35152724 DOI: 10.1177/00099228221080340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
6
|
Eichler N, Joseph L, Megged O, Goldberg S, Picard E. The impact of pneumococcal conjugate vaccine on the prevalence and severity of hospitalizations for pneumonia in children. Eur J Clin Microbiol Infect Dis 2022; 41:439-444. [PMID: 34997390 DOI: 10.1007/s10096-021-04386-0] [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: 06/17/2021] [Accepted: 11/20/2021] [Indexed: 11/03/2022]
Abstract
Pneumococcal conjugate vaccines (PCV) were introduced into the Israeli national immunization plan starting with the heptavalent PCV7 in 2009 and then PCV13 in the late 2010. The objective of this study was to determine the vaccines' impact on hospitalization rates for community-acquired pneumonia on the severity of the pneumonia episodes and upon pneumococcal serotype distribution. We retrospectively reviewed all children hospitalized in our institution with pneumonia, aged between 1 and 16 years, between the years 2006 and 2015. Demographic, clinical, and laboratory data between three time periods: pre-PCV, PCV7, and PCV13, were compared. During the study period, 1375 children were hospitalized with pneumonia. A gradual decline in hospitalization rates due to pneumonia was observed starting in 2006 in the pre-PCV period and continued until after the introduction of PCV13. A similar trend was observed in pneumonias with a culture positive for S. pneumoniae. Pleural effusion was observed in 24% of all pneumonias, and this percentage was stable throughout the study period. The average age at hospitalization increased during the study period, as did the average duration of hospital stay. Pneumococcal serotypes included in the vaccine were isolated less frequently during the study and non-vaccine serotypes tended to appear more frequently. Pediatric pneumonia hospitalization rates continued to decline since the introduction of PCV without increasing the frequency of complications. Pneumococcal serotype distribution shifted in parallel. Our findings confirm the efficacy of PCV and support the evidence to include more serotypes in the next generation of PCV.
Collapse
Affiliation(s)
- Noam Eichler
- Pediatric Pulmonology Institute, Shaare Zedek Medical Center, affiliated with The Hebrew University, School of Medicine, Jerusalem, Israel
| | - Leon Joseph
- Pediatric Pulmonology Institute, Shaare Zedek Medical Center, affiliated with The Hebrew University, School of Medicine, Jerusalem, Israel
| | - Orli Megged
- Pediatric Infectious Unit, Shaare Zedek Medical Center, affiliated with The Hebrew University, School of Medicine, Jerusalem, Israel
| | - Shmuel Goldberg
- Pediatric Pulmonology Institute, Shaare Zedek Medical Center, affiliated with The Hebrew University, School of Medicine, Jerusalem, Israel
| | - Elie Picard
- Pediatric Pulmonology Institute, Shaare Zedek Medical Center, affiliated with The Hebrew University, School of Medicine, Jerusalem, Israel.
| |
Collapse
|
7
|
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.
Collapse
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.
| |
Collapse
|
8
|
de-Miguel-Díez J, López-de-Andrés A, Hernández-Barrera V, de-Miguel-Yanes JM, Carabantes-Alarcón D, Ji Z, Zamorano-Leon JJ, Jiménez-García R. Sex-differences in incidence of hospitalizations and in hospital mortality of community-acquired pneumonia among children in Spain: a population-based study. Eur J Pediatr 2022; 181:2705-2713. [PMID: 35469030 PMCID: PMC9192385 DOI: 10.1007/s00431-022-04478-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 04/13/2022] [Accepted: 04/13/2022] [Indexed: 12/01/2022]
Abstract
UNLABELLED The aim of this study is to examine trends from 2016 to 2019 in the incidence of hospitalizations and in-hospital mortality (IHM) of subjects < 18 years with community-acquired pneumonia (CAP), assessing possible sex differences. We used Spanish national hospital discharge data to select all patients < 18 years with CAP. We identified 43,511 children (53% boys) hospitalized with CAP. The incidence of CAP was significantly higher in boys than in girls, with an age-adjusted incidence rate ratio of 1.05 (95%CI 1.03-1.07) for boys compared to girls, and rose from 126 per 100,000 children in 2016 to 131 in 2019 (p < 0.0001). There were no sex differences in isolated pathogens, comorbidities, length of hospital stay, or IHM. Variables independently associated with IHM were age 10 to 17 years, congenital heart disease, neurological diseases, and use of invasive mechanical ventilation. Asthma was a protective factor for IHM among girls. CONCLUSION The incidence of hospital admissions for CAP was higher among boys than among girls and rose significantly from 2016 to 2019. There were no sex differences in hospital outcomes. Age 10 to 17 years, congenital heart disease, neurological diseases, and use of mechanical ventilation were risk factors for IHM in both sexes, while asthma was a protective factor among girls. No differences were found in IHM over time. WHAT IS KNOWN • Community-acquired pneumonia is one of the most common reasons for hospitalizations among children. • There are few studies that allow to know the evolution of community-acquired pneumonia in children. WHAT IS NEW • Incidence of hospital admissions for community-acquired pneumonia was higher in boys than girls and it rose significantly from 2016 to 2019. • Age 10 to 17 years, congenital heart disease, neurological diseases and use of mechanical ventilation were risk factors for in-hospital mortality in both sexes.
Collapse
Affiliation(s)
- Javier de-Miguel-Díez
- grid.4795.f0000 0001 2157 7667Respiratory Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Faculty of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Ana López-de-Andrés
- Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, 28040, Madrid, Spain.
| | - Valentín Hernández-Barrera
- grid.28479.300000 0001 2206 5938Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Universidad Rey Juan Carlos, 28922 Madrid, Spain
| | - José M. de-Miguel-Yanes
- grid.4795.f0000 0001 2157 7667Internal Medicine Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Faculty of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - David Carabantes-Alarcón
- grid.4795.f0000 0001 2157 7667Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Zichen Ji
- grid.4795.f0000 0001 2157 7667Respiratory Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Faculty of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Jose J. Zamorano-Leon
- grid.4795.f0000 0001 2157 7667Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Rodrigo Jiménez-García
- grid.4795.f0000 0001 2157 7667Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain
| |
Collapse
|
9
|
Khalid OM, Omer MB, Kardman SE, Yagi HI. A prospective study of acute sinusitis, clinical features and modalities of management in adults, Sudan. THE EGYPTIAN JOURNAL OF OTOLARYNGOLOGY 2022; 38:129. [PMCID: PMC9527394 DOI: 10.1186/s43163-022-00316-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Background Acute sinusitis is not an uncommon disease that manifests with inflammation of the mucosal lining of the paranasal sinuses. It has varied etiologies including viral, bacterial, fungal, and allergic. Anatomical variations, trauma, auto-immunity, diabetes mellitus, and dental procedures are predisposing factors. With the wide variation in the etiological factors, the management could be tricky. This study is quite relevant with the advent of the relentlessly persisting COVID-19 pandemic which affects the upper respiratory tract as well. Methods This is a descriptive hospital-based prospective study conducted at the Khartoum ENT Teaching Hospital, Ibnsina Teaching Hospital, Omdurman Military Hospital, and Omdurman Teaching Hospital in Khartoum State in the period from March 2020 to February 2021. The study included all patients 18 years and older diagnosed with acute sinusitis. The data was collected by a well-structured questionnaire designed to meet the objectives of the study and analyzed using SPSS 20. Any COVID-19 suspect is excluded from the study. Results The total number of patients was 109; of them, 59 (54.1%) were females and 50 (45.9%) were males, and the female to male ratio was 1.18:1. One hundred seven (98.2%) patients received medical treatment and two patients (1.8%) did take the medications. Eighty-one patients (74.3%) were cured with medical treatment and only 28 patients (25.7%) needed surgical intervention. The age group from 25 to 40 years old was the most affected, accounting for 68 patients (62.4%), and the above 60 years old (3.7%) was the least affected group. Conclusion Acute sinusitis is not an uncommon disease, if addressed properly and timely is medically treatable in most cases apart from complicated cases. This study shows that the active working ages (25-40) were the most affected. Few patients needed surgery (FESS). Negligence could result in complications. Diseases like COVID-19 affect the upper respiratory tract, and there is a similarity in symptoms, and in the advent of the COVID-19 pandemic nowadays, differentiation is of paramount importance.
Collapse
Affiliation(s)
- Osama M. Khalid
- grid.9763.b0000 0001 0674 6207Department of Otolaryngology, Faculty of Medicine, University of Khartoum, Khartoum, Sudan
| | | | - Siddig E. Kardman
- grid.9763.b0000 0001 0674 6207Department of Otolaryngology, Faculty of Medicine, University of Khartoum, Khartoum, Sudan
| | - Hashim I. Yagi
- grid.9763.b0000 0001 0674 6207Department of Otolaryngology, Faculty of Medicine, University of Khartoum, Khartoum, Sudan
| |
Collapse
|
10
|
Impact of 7-valent versus 10-valent pneumococcal conjugate vaccines on primary care consultations across various age groups in the Netherlands, 5 years after the switch: A time-series analysis. Vaccine 2021; 40:334-343. [PMID: 34969546 DOI: 10.1016/j.vaccine.2021.11.059] [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: 02/09/2021] [Revised: 11/19/2021] [Accepted: 11/22/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND In 2011, 10-valent pneumococcal conjugate vaccine (PCV10) replaced PCV7 in The Netherlands. We aimed to assess the impact of this switch on non-invasive pneumococcal disease in primary care across various age-groups, including pneumonia-bronchitis, otitis media (OM) and sinusitis with and without considering pre-PCV10 secular trends. METHODS Electronic records of 397,441 individuals included in a regional primary care database from July 2006 to June 2016 were extracted (2,408,762 person-years). We fitted interrupted time-series on annual incidence rates (IR) of primary care diagnosed pneumonia-bronchitis, OM and sinusitis episodes per age-group. We performed these two types of analyses, comparing; 1) the post-PCV10 observed versus expected trend if PCV10 had not been implemented and pre-PCV10 secular trends had continued 2), the pre- versus post-PCV10 observed, model fitted trend. The latter assumes no secular trend. Incidence rate ratios (IRR) were calculated using both methods. RESULTS We found significant reductions following PCV10 introduction with both analysis methods for pneumonia-bronchitis in the pediatric and adult age-groups, for sinusitis in the age-group 20-50 years and for OM, the effect across various age-groups are uncertain given contradictory results. For other outcomes and age-groups, the effect estimates were not consistent across the two-method used and heavily depended on the strength of the underlying trend. No consistent effects were observed in the elderly population, considering the two methods used. CONCLUSION Our study supports some direct and indirect-effect of PCV10 introduction on non-IPD, mainly on pneumonia-bronchitis, but estimates heavily depend on the method of analysis used. Estimates from the two different approaches may differ substantially if underlying trends are strong.
Collapse
|
11
|
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.
Collapse
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)
| |
Collapse
|
12
|
Lewnard JA, King LM, Fleming-Dutra KE, Link-Gelles R, Van Beneden CA. Incidence of Pharyngitis, Sinusitis, Acute Otitis Media, and Outpatient Antibiotic Prescribing Preventable by Vaccination Against Group A Streptococcus in the United States. Clin Infect Dis 2021; 73:e47-e58. [PMID: 32374829 DOI: 10.1093/cid/ciaa529] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Accepted: 04/30/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Group A Streptococcus (GAS) is a leading cause of acute respiratory conditions that frequently result in antibiotic prescribing. Vaccines against GAS are currently in development. METHODS We estimated the incidence rates of healthcare visits and antibiotic prescribing for pharyngitis, sinusitis, and acute otitis media (AOM) in the United States using nationally representative surveys of outpatient care provision, supplemented by insurance claims data. We estimated the proportion of these episodes attributable to GAS and to GAS emm types included in a proposed 30-valent vaccine. We used these outputs to estimate the incidence rates of outpatient visits and antibiotic prescribing preventable by GAS vaccines with various efficacy profiles under infant and school-age dosing schedules. RESULTS GAS pharyngitis causes 19.1 (95% confidence interval [CI], 17.3-21.1) outpatient visits and 10.2 (95% CI, 9.0-11.5) antibiotic prescriptions per 1000 US persons aged 0-64 years, annually. GAS pharyngitis causes 93.2 (95% CI, 82.3-105.3) visits and 53.2 (95% CI, 45.2-62.5) antibiotic prescriptions per 1000 children ages 3-9 years, annually, representing 5.9% (95% CI, 5.1-7.0%) of all outpatient antibiotic prescribing in this age group. Collectively, GAS-attributable pharyngitis, sinusitis, and AOM cause 26.9 (95% CI, 23.9-30.8) outpatient visits and 16.1 (95% CI, 14.0-18.7) antibiotic prescriptions per 1000 population, annually. A 30-valent GAS vaccine meeting the World Health Organization's 80% efficacy target could prevent 5.4% (95% CI, 4.6-6.4%) of outpatient antibiotic prescriptions among children aged 3-9 years. If vaccine prevention of GAS pharyngitis made the routine antibiotic treatment of pharyngitis unnecessary, up to 17.1% (95% CI, 15.0-19.6%) of outpatient antibiotic prescriptions among children aged 3-9 years could be prevented. CONCLUSIONS An efficacious GAS vaccine could prevent substantial incidences of pharyngitis infections and associated antibiotic prescribing in the United States.
Collapse
Affiliation(s)
- Joseph A Lewnard
- Division of Epidemiology, School of Public Health, University of California, Berkeley, California, USA.,Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, California, USA.,Center for Computational Biology, School of Engineering, University of California, Berkeley, California, USA
| | - Laura M King
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Katherine E Fleming-Dutra
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ruth Link-Gelles
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Chris A Van Beneden
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| |
Collapse
|
13
|
Vadlamudi NK, Saatchi A, Patrick DM, Rose C, Sadatsafavi M, Marra F. Impact of the 13-valent pneumococcal conjugate vaccine on acute otitis media and acute sinusitis epidemiology in British Columbia, Canada. J Antimicrob Chemother 2021; 76:2419-2427. [PMID: 34021757 DOI: 10.1093/jac/dkab167] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 04/26/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Numerous studies have characterized the 13-valent pneumococcal conjugate vaccine (PCV13) programme's beneficial effects on acute otitis media (AOM) and acute sinusitis (AS) rates in children; however, few studies have examined the impact on adults. OBJECTIVES This retrospective cohort study evaluates the overall effect of the PCV13 immunization programme on the incidence of AOM and AS at the population level. METHODS Health administrative databases were linked to assess outpatient visits, hospitalizations and antibiotic utilization from 2000 to 2018. Multivariable Poisson regression was used to evaluate the impact of the PCV13 vaccine programme (2011-18) compared with the pre-PCV13 era (2000-10), overall and by age. RESULTS From 2000 to 2018, the incidence of AOM decreased by 50% (62 to 31 per 1000 population) while sinusitis decreased by 18% (33 to 27 per 1000 population). In the PCV13 era, the incidence of AOM declined [incidence rate ratio (IRR): 0.70; 95% CI: 0.70-0.70], in parallel with decreased incidence of antibiotic utilization (IRR: 0.65; 95% CI: 0.64-0.65). A reduction was also observed in the incidence of AS during the PCV13 era compared with the pre-PCV13 era (IRR: 0.88; 95% CI: 0.88-0.88), mainly driven by declines among those younger than 65 years of age. In contrast, an increase in AS incidence was noted in individuals aged ≥65 years (IRR: 1.03; 95% CI: 1.02-1.03). A decrease in antibiotic prescription rates for sinusitis was observed for those under 65 years of age. CONCLUSIONS The PCV13 immunization programme is associated with a reduction in the incidence of AOM and AS. Moreover, the associated use of antibiotics for these diagnoses has comparably decreased across paediatric, as well as adult populations.
Collapse
Affiliation(s)
| | - Ariana Saatchi
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada
| | - 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
| | - Caren Rose
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, Canada.,British Columbia Centre for Disease Control, Vancouver, Canada
| | - Mohsen Sadatsafavi
- Faculty of Pharmaceutical Sciences, University of British Columbia, 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
| |
Collapse
|
14
|
Esposito S, Dal Canto G, Caramia MR, Fainardi V, Pisi G, Principi N. Complications in community acquired pneumonia: magnitude of problem, risk factors, and management in pediatric age. Expert Rev Anti Infect Ther 2021; 20:45-51. [PMID: 33971782 DOI: 10.1080/14787210.2021.1927710] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Introduction: In the last decades, the large use of several effective vaccines has dramatically reduced the incidence of community acquired pneumonia (CAP) in infants and children. Moreover, the availability of new antibiotics effective against emerging resistant strains of bacteria has greatly improved the early and long-term prognosis of this disease.Areas covered: The aim of this manuscript is to evaluate the burden of complicated CAP in pediatric age and to discuss its appropriate management.Expert opinion: Complicated CAP remains a problem for children in industrialized and developing countries. A larger use of lung ultrasonography (US) as first diagnostic approach could significantly improve early identification of cases at higher risk of complications. Difficult to solve, is the problem of the use of an antibiotic therapy able to assure adequate control in all the CAP cases, including those at high risk of or with already established complications. All these findings reveal that control of the incidence of complicated CAP remains difficult and will not be significantly changed in the next few years. Any attempt to improve complicated CAP management must be made. Consensus documents on better definition of the use of corticosteroids, fibrinolytic agents, and interventional procedures (including surgery) can allow us to reach this goal.
Collapse
Affiliation(s)
- Susanna Esposito
- Pediatric Clinic, Pietro Barilla Children's Hospital, University of Parma, Parma, Italy
| | - Giulia Dal Canto
- Pediatric Clinic, Pietro Barilla Children's Hospital, University of Parma, Parma, Italy
| | - Maria Rosaria Caramia
- Pediatric Clinic, Pietro Barilla Children's Hospital, University of Parma, Parma, Italy
| | - Valentina Fainardi
- Pediatric Clinic, Pietro Barilla Children's Hospital, University of Parma, Parma, Italy
| | - Giovanna Pisi
- Pediatric Clinic, Pietro Barilla Children's Hospital, University of Parma, Parma, Italy
| | | |
Collapse
|
15
|
Etiology of Clinical Community-Acquired Pneumonia in Swedish Children Aged 1-59 Months with High Pneumococcal Vaccine Coverage-The TREND Study. Vaccines (Basel) 2021; 9:vaccines9040384. [PMID: 33919904 PMCID: PMC8070909 DOI: 10.3390/vaccines9040384] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 04/05/2021] [Accepted: 04/12/2021] [Indexed: 10/25/2022] Open
Abstract
(1) Immunization with pneumococcal conjugate vaccines has decreased the burden of community-acquired pneumonia (CAP) in children and likely led to a shift in CAP etiology. (2) The Trial of Respiratory infections in children for ENhanced Diagnostics (TREND) enrolled children 1-59 months with clinical CAP according to the World Health Organization (WHO) criteria at Sachs' Children and Youth Hospital, Stockholm, Sweden. Children with rhonchi and indrawing underwent "bronchodilator challenge". C-reactive protein and nasopharyngeal PCR detecting 20 respiratory pathogens, were collected from all children. Etiology was defined according to an a priori defined algorithm based on microbiological, biochemical, and radiological findings. (3) Of 327 enrolled children, 107 (32%) required hospitalization; 91 (28%) received antibiotic treatment; 77 (24%) had a chest X-ray performed; and 60 (18%) responded to bronchodilator challenge. 243 (74%) episodes were classified as viral, 11 (3%) as mixed viral-bacterial, five (2%) as bacterial, two (0.6%) as atypical bacterial and 66 (20%) as undetermined etiology. After exclusion of children responding to bronchodilator challenge, the proportion of bacterial and mixed viral-bacterial etiology was 1% and 4%, respectively. (4) The novel TREND etiology algorithm classified the majority of clinical CAP episodes as of viral etiology, whereas bacterial etiology was uncommon. Defining CAP in children <5 years is challenging, and the WHO definition of clinical CAP is not suitable for use in children immunized with pneumococcal conjugate vaccines.
Collapse
|
16
|
Rhedin S, Lundholm C, Osvald EC, Almqvist C. Pneumonia in Infancy and Risk for Asthma: The Role of Familial Confounding and Pneumococcal Vaccination. Chest 2021; 160:422-431. [PMID: 33727032 PMCID: PMC8411448 DOI: 10.1016/j.chest.2021.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 02/11/2021] [Accepted: 03/04/2021] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND Studies have reported an increased risk for asthma following lower respiratory tract infections, but few studies have specifically assessed this risk in children diagnosed with pneumonia in infancy. Furthermore, it is not fully understood whether this association is indicative of a causal relationship or if certain children have a predisposition for both diseases. RESEARCH QUESTION Are children diagnosed with pneumonia in infancy at increased risk for asthma, and what is the role of familial confounding and pneumococcal conjugate vaccine immunization on the association? STUDY DESIGN AND METHODS This study was a nationwide register-based cohort analysis of > 900,000 Swedish children to assess the association between pneumonia in infancy and prevalent asthma at 4 years. A secondary aim was to assess if the association has changed after the introduction of nationwide pneumococcal conjugate vaccine (PCV) immunization as this has led to a shift in pneumonia etiology. The study controlled for important confounders, including shared environmental and familial confounding, by using sibling analyses. RESULTS There was a strong association between pneumonia diagnosis in infancy and prevalent asthma at 4 years (adjusted OR, 3.38; 95% CI, 3.26-3.51), as well as in the full sibling analyses (adjusted OR, 2.81; 95% CI, 2.58-3.06). The risk for asthma following pneumonia diagnosis in infancy was slightly higher for those born in the PCV period compared with the pre-PCV period (adjusted OR, 3.80 [95% CI, 3.41-4.24] vs 3.28 [95% CI, 3.15-3.42]) when the proportion of viral pneumonia etiology was also higher (14.5% vs 10.7%, respectively) and the overall asthma prevalence was lower (5.3% vs 6.6%). INTERPRETATION Children diagnosed with pneumonia in infancy have a highly increased risk for prevalent asthma at 4 years, which might have implications for future asthma preventive measures and needs to be considered when assessing the morbidity that can be attributed to pneumonia.
Collapse
Affiliation(s)
- Samuel Rhedin
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Sachs' Children and Youth Hospital, Stockholm, Sweden.
| | - Cecilia Lundholm
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Emma Caffrey Osvald
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Pediatric Allergy and Pulmonology Unit at Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Catarina Almqvist
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Pediatric Allergy and Pulmonology Unit at Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| |
Collapse
|
17
|
Strachan R, Homaira N, Beggs S, Bhuiyan MU, Gilbert GL, Lambert SB, Macartney K, Marshall H, Martin AC, McCallum GB, McCullagh A, McDonald T, McIntyre P, Oftadeh S, Ranganathan S, Suresh S, Wainwright CE, Wilson A, Wong M, Snelling T, Jaffé A. Assessing the impact of the 13 valent pneumococcal vaccine on childhood empyema in Australia. Thorax 2021; 76:487-493. [PMID: 33504566 DOI: 10.1136/thoraxjnl-2020-216032] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 11/04/2020] [Accepted: 12/04/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Empyema is a serious complication of pneumonia frequently caused by Streptococcus pneumoniae (SP). We assessed the impact of the 13-valent pneumococcal conjugate vaccine (13vPCV) on childhood pneumonia and empyema after inclusion in the Australian National Immunisation Program. METHODS For bacterial pneumonia and empyema hospitalisations, we ascertained incidence rates (IRs) using the National Hospital Morbidity Database International Statistical Classification of Disease discharge codes and relevant population denominators, and calculated incidence rate ratios (IRR) comparing the 13vPCV period (June 2012-May 2017) with the 7vPCV period (June 2007-May 2011). Blood and pleural fluid (PF) cultures and PF PCR of 401 children with empyema from 11 Australian hospitals during the 13vPCV period were compared with our previous study in the 7vPCV period. FINDINGS Across 7vPCV and 13vPCV periods, IRs per million children (95% CIs) were 1605 (1588 to 1621) and 1272 (1259 to 1285) for bacterial pneumonia, and 14.23 (12.67 to 15.79) and 17.89 (16.37 to 19.42) for empyema hospitalisations. IRRs were 0.79 (0.78 to 0.80) for bacterial pneumonia and 1.25 (1.09 to 1.44) for empyema. Of 161 empyema cases with SP serotypes, 147 (91.3%) were vaccine types. ST3 accounted for 76.4% of identified serotypes in the 13vPCV period, more than double than the 7vPCV period (p<0.001); ST19A decreased from 36.4% to 12.4%. No cases of ST1 empyema were identified in the 13vPCV period versus 14.5% in the 7vPCV period. INTERPRETATION 13vPCV resulted in a significant reduction in all-cause hospitalisations for bacterial pneumonia but empyema hospitalisations significantly increased, with emergence of pneumococcal ST3 as the dominant serotype in empyema. TRIAL REGISTRATION NUMBER Australian and New Zealand Clinical Trial Registry ACTRN 12614000354684.
Collapse
Affiliation(s)
- Roxanne Strachan
- Department of Respiratory Medicine, Sydney Children's Hospital Randwick, Randwick, New South Wales, Australia
| | - Nusrat Homaira
- Department of Respiratory Medicine, Sydney Children's Hospital Randwick, Randwick, New South Wales, Australia.,School of Women's and Children's Health, University of New South Wales-Kensington Campus, Sydney, New South Wales, Australia
| | - Sean Beggs
- Department of Paediatrics, Royal Hobart Hospital, Hobart, Tasmania, Australia.,School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Mejbah U Bhuiyan
- Division of Paediatrics, School of Medicine, Faculty of Health and Medical Science, University of Western Australia, Crawley, Western Australia, Australia.,Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Gwendolyn L Gilbert
- Marie Bashir Institute for Infectious Diseases and Biosecurity, The University of Sydney, Sydney, New South Wales, Australia
| | - Stephen B Lambert
- School of Medicine, University of Queensland, UQ Child Health Research Centre, Brisbane, Queensland, Australia.,Children's Health Queensland, Queensland Paediatric Infectious Diseases Laboratory, Brisbane, Queensland, Australia
| | - Kristine Macartney
- Infectious Diseases, Children's Hospital at Westmead, Westmead, New South Wales, Australia.,National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, Westmead, New South Wales, Australia
| | - Helen Marshall
- Vaccinology and Immunology Research Trials Unit, Women's and Children's Hospital, Women's and Children's Health Network, North Adelaide, South Australia, Australia.,Child and Adolescent Health, Robinson Research Institute, The University of Adelaide, North Adelaide, South Australia, Australia
| | - Andrew C Martin
- Paediatrics, Princess Margaret Hospital For Children, Perth, Western Australia, Australia
| | - Gabrielle B McCallum
- Child Health Division, Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Angela McCullagh
- Respiratory and Sleep Medicine, Monash Children's Hospital, Melbourne, Victoria, Australia.,Paediatrics, Monash University, Clayton, Victoria, Australia
| | - Tim McDonald
- Paediatrics, Canberra Hospital, Canberra, Australian Capital Territory, Australia
| | - Peter McIntyre
- Infectious Diseases, Children's Hospital at Westmead, Westmead, New South Wales, Australia.,Women's and Children's Health, University of Otago-Dunedin Campus, Dunedin, New Zealand
| | - Shahin Oftadeh
- Centre for Infectious Diseases and Microbiology Laboratory Services, Institute of Clinical Pathology and Medical Research, Wentworthville, New South Wales, Australia
| | - Sarath Ranganathan
- Paediatrics, The University of Melbourne Department of Paediatrics, Parkville, Victoria, Australia.,Infection and Immunology, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Sadasivam Suresh
- Department of Respiratory Medicine, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Claire E Wainwright
- Respiratory and Sleep Medicine, Queensland Children's Hospital, South Brisbane, Queensland, Australia.,Child Health Research Centre, The University of Queensland, South Brisbane, Queensland, Australia
| | - Angela Wilson
- Department of Paediatrics, Alice Springs Hospital, Alice Springs, Northern Territory, Australia
| | - Melanie Wong
- Immunology, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Thomas Snelling
- School of Women's and Children's Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Adam Jaffé
- Department of Respiratory Medicine, Sydney Children's Hospital Randwick, Randwick, New South Wales, Australia.,School of Women's and Children's Health, University of New South Wales-Kensington Campus, Sydney, New South Wales, Australia
| |
Collapse
|
18
|
Gönüllü E, Soysal A, Yıldız I, Aydemir G, Tunç T, Karaböcüoğlu M. Impact of the 13-valent pneumococcal conjugate vaccine on the incidences of community-acquired pneumonia and pneumonia-related hospitalizations in children ≤5 years after its implementation into the national immunization program of Turkey. Hum Vaccin Immunother 2020; 16:2504-2508. [DOI: 10.1080/21645515.2020.1727212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Affiliation(s)
- Erdem Gönüllü
- Clinic of Pediatrics, Ataşehir Memorial Hospital, Istanbul, Turkey
| | - Ahmet Soysal
- Clinic of Pediatrics, Ataşehir Memorial Hospital, Istanbul, Turkey
| | - Ismail Yıldız
- Clinic of Pediatrics, Şişli Memorial Hospital, Istanbul, Turkey
| | - Gökhan Aydemir
- Clinic of Pediatrics, Ataşehir Memorial Hospital, Istanbul, Turkey
| | - Turan Tunç
- Clinic of Pediatrics, Ataşehir Memorial Hospital, Istanbul, Turkey
| | | |
Collapse
|
19
|
Dykewicz MS, Wallace DV, Amrol DJ, Baroody FM, Bernstein JA, Craig TJ, Dinakar C, Ellis AK, Finegold I, Golden DBK, Greenhawt MJ, Hagan JB, Horner CC, Khan DA, Lang DM, Larenas-Linnemann DES, Lieberman JA, Meltzer EO, Oppenheimer JJ, Rank MA, Shaker MS, Shaw JL, Steven GC, Stukus DR, Wang J, Dykewicz MS, Wallace DV, Dinakar C, Ellis AK, Golden DBK, Greenhawt MJ, Horner CC, Khan DA, Lang DM, Lieberman JA, Oppenheimer JJ, Rank MA, Shaker MS, Stukus DR, Wang J, Dykewicz MS, Wallace DV, Amrol DJ, Baroody FM, Bernstein JA, Craig TJ, Finegold I, Hagan JB, Larenas-Linnemann DES, Meltzer EO, Shaw JL, Steven GC. Rhinitis 2020: A practice parameter update. J Allergy Clin Immunol 2020; 146:721-767. [PMID: 32707227 DOI: 10.1016/j.jaci.2020.07.007] [Citation(s) in RCA: 110] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 06/22/2020] [Accepted: 07/01/2020] [Indexed: 12/12/2022]
Abstract
This comprehensive practice parameter for allergic rhinitis (AR) and nonallergic rhinitis (NAR) provides updated guidance on diagnosis, assessment, selection of monotherapy and combination pharmacologic options, and allergen immunotherapy for AR. Newer information about local AR is reviewed. Cough is emphasized as a common symptom in both AR and NAR. Food allergy testing is not recommended in the routine evaluation of rhinitis. Intranasal corticosteroids (INCS) remain the preferred monotherapy for persistent AR, but additional studies support the additive benefit of combination treatment with INCS and intranasal antihistamines in both AR and NAR. Either intranasal antihistamines or INCS may be offered as first-line monotherapy for NAR. Montelukast should only be used for AR if there has been an inadequate response or intolerance to alternative therapies. Depot parenteral corticosteroids are not recommended for treatment of AR due to potential risks. While intranasal decongestants generally should be limited to short-term use to prevent rebound congestion, in limited circumstances, patients receiving regimens that include an INCS may be offered, in addition, an intranasal decongestant for up to 4 weeks. Neither acupuncture nor herbal products have adequate studies to support their use for AR. Oral decongestants should be avoided during the first trimester of pregnancy. Recommendations for use of subcutaneous and sublingual tablet allergen immunotherapy in AR are provided. Algorithms based on a combination of evidence and expert opinion are provided to guide in the selection of pharmacologic options for intermittent and persistent AR and NAR.
Collapse
Affiliation(s)
- Mark S Dykewicz
- Section of Allergy and Immunology, Division of Infectious Diseases, Allergy and Immunology, Department of Internal Medicine, School of Medicine, Saint Louis University, St Louis, Mo.
| | - Dana V Wallace
- Department of Medicine, Nova Southeastern Allopathic Medical School, Fort Lauderdale, Fla
| | - David J Amrol
- Department of Internal Medicine, School of Medicine, University of South Carolina, Columbia, SC
| | - Fuad M Baroody
- Department of Otolaryngology-Head and Neck Surgery, Pritzker School of Medicine, University of Chicago, Chicago, Ill
| | - Jonathan A Bernstein
- Allergy Section, Division of Immunology, Department of Internal Medicine, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Timothy J Craig
- Departments of Medicine and Pediatrics, Penn State University, Hershey, Pa
| | - Chitra Dinakar
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, School of Medicine, Stanford University, Stanford, Calif
| | - Anne K Ellis
- Division of Allergy and Immunology, Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Ira Finegold
- Division of Allergy and Immunology, Department of Medicine, Mount Sinai West, New York, NY
| | - David B K Golden
- Division of Allergy and Clinical Immunology, Department of Medicine, School of Medicine, John Hopkins University, Baltimore, Md
| | - Matthew J Greenhawt
- Section of Allergy and Immunology, Department of Pediatrics, Children's Hospital Colorado, School of Medicine, University of Colorado, Aurora, Colo
| | - John B Hagan
- Division of Allergic Diseases, Mayo Clinic, Rochester, Minn
| | - Caroline C Horner
- Division of Allergy, Immunology and Pulmonary Medicine, Department of Pediatrics, School of Medicine, Washington University, St Louis, Mo
| | - David A Khan
- Division of Allergy and Immunology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Tex
| | - David M Lang
- Department of Allergy and Clinical Immunology, Respiratory Institute, Cleveland Clinic Lerner College of Medicine at Case Western Reserve University, Cleveland, Ohio
| | | | - Jay A Lieberman
- Division of Pulmonology Allergy and Immunology, Department of Pediatrics, The University of Tennessee Health Science Center, Memphis, Tenn
| | - Eli O Meltzer
- Division of Allergy and Immunology, Department of Pediatrics, School of Medicine, University of California, San Diego, Calif; Allergy and Asthma Medical Group and Research Center, San Diego, Calif
| | - John J Oppenheimer
- Division of Pulmonary & Critical Care Medicine and Allergic & Immunologic Diseases, Department of Internal Medicine, University of Medicine and Dentistry of New Jersey-Rutgers New Jersey Medical School, New Brunswick, NJ; Pulmonary and Allergy Associates, Morristown, NJ
| | - Matthew A Rank
- Division of Allergy, Asthma, and Clinical Immunology, Mayo Clinic in Arizona, Scottsdale, Ariz
| | - Marcus S Shaker
- Department of Pediatrics, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | | | | | - David R Stukus
- Division of Allergy and Immunology, Nationwide Children's Hospital, Columbus, Ohio; Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, Ohio
| | - Julie Wang
- Division of Allergy and Immunology, Department of Pediatrics, The Elliot and Roslyn Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Kaboré L, Ouattara S, Sawadogo F, Gervaix A, Galetto-Lacour A, Karama R, Traoré AT, Méda B, Tall H, Essoh AT, Gessner BD, Moïsi JC. Impact of 13-valent pneumococcal conjugate vaccine on the incidence of hospitalizations for all-cause pneumonia among children aged less than 5 years in Burkina Faso: An interrupted time-series analysis. Int J Infect Dis 2020; 96:31-38. [DOI: 10.1016/j.ijid.2020.03.051] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 03/18/2020] [Accepted: 03/20/2020] [Indexed: 10/24/2022] Open
|
21
|
Zhou Z, Gilca R, Deceuninck G, Boucher F, De Wals P. Hospitalizations for lower respiratory tract infections in children in relation to the sequential use of three pneumococcal vaccines in Quebec. Canadian Journal of Public Health 2020; 111:1041-1048. [PMID: 32529553 DOI: 10.17269/s41997-020-00329-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 04/27/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVES In Quebec, three pneumococcal conjugate vaccines (PCV) were used sequentially starting in December 2004. The objective of the study was to investigate the association between exposure to different PCV regimens and hospitalizations for lower respiratory tract infection (LRTI). METHODS Records with a main diagnosis of LRTI in children born in 2000-2012 and observed up to their second birthday were extracted from the provincial hospital administrative database. Main vaccine regimen in different birth cohorts was derived from the Quebec City Immunization Registry. Hospital admission risk was analyzed by Poisson regression models adjusting for age, season of birth, ambient air temperature, circulation of respiratory viruses, and the weekly hospital admission rate for all other causes excluding LRTI to control for temporal changes in hospital admission practices. RESULTS In univariate analyses, hospitalizations for LRTI, pneumonia, and bronchiolitis were less frequent in cohorts exposed to PCVs than in unvaccinated cohorts with no difference between PCV regimens. For pneumonia, the difference in cumulative incidence was 16% (13%; 18%). In multivariate analyses, exposure to any PCV schedule was associated with a lower although statistically non-significant hospitalization risk for pneumonia as compared with unvaccinated cohorts. Again, differences between PCV regimens were minimal. CONCLUSIONS Interpretation of results of this ecological study should be made with care as many factors could influence hospitalizations for respiratory infection in young children. Results are compatible with a modest effect of PCVs in reducing hospitalizations for pneumonia in children. No substantial differences between various PCV schedules were observed.
Collapse
Affiliation(s)
- Zhou Zhou
- Quebec University Hospital Research Centre, Quebec City, Canada
| | - Rodica Gilca
- Quebec University Hospital Research Centre, Quebec City, Canada.,Institut national de santé publique du Québe, Quebec City, Canada
| | | | - François Boucher
- Quebec University Hospital Research Centre, Quebec City, Canada.,Department of Pediatrics, Laval University, Quebec City, Canada
| | - Philippe De Wals
- Quebec University Hospital Research Centre, Quebec City, Canada. .,Institut national de santé publique du Québe, Quebec City, Canada. .,Department of Social and Preventive Medicine, Laval University, Quebec City, Canada.
| |
Collapse
|
22
|
Chen YC, Chen HH, Janapatla RP, Dudek A, Hsu MH, Chen CL, Chiu CH. Thomsen-Friedenreich antigen activation as a predictor for clinical outcome of pediatric patients with invasive pneumococcal disease. Pediatr Neonatol 2020; 61:338-342. [PMID: 32156480 DOI: 10.1016/j.pedneo.2020.02.005] [Citation(s) in RCA: 4] [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] [Received: 10/08/2019] [Revised: 11/17/2019] [Accepted: 02/15/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The most severe form of pneumococcal disease is invasive pneumococcal disease (IPD), including empyema, sepsis and meningitis. Thomsen-Friedenreich antigen (TA; Galβ1-3GalNAc) activation is known to be a predictor of Streptococcus pneumoniae-associated hemolytic uremic syndrome (Sp-HUS). There have been limited data to correlate TA activation and overall disease severity of IPD in children. The study aimed to prove the positive correlation between TA activation and disease severity and to demonstrate the trend of TA level during the disease course. METHODS We retrospectively reviewed the medical records from 38 pediatric patients aged from 0 to 18 years with microbiologically-confirmed IPD between 2010 and 2015 at a medical center in Taiwan. All cases underwent TA activation testing by the fluorescence-labeled peanut lectin agglutination method. Medical information including demographic data, laboratory findings, co-morbidities, and outcome was collected and reviewed. We compared the clinical manifestations and associated co-morbidities between TA-positive and TA-negative patients. RESULTS Among the 38 patients, 25 (66%) showed TA activation. Compared to TA-negative patients, patients with TA activation had a statistically higher rate of prolonged anemia, thrombocytopenia, and acute kidney injury. TA-positive patients also had a longer intensive care unit stay and overall hospitalization days. The TA levels usually peaked 5-10 days after disease onset. Twenty-one pneumococcal isolates were recovered from the patients and serotyping was determined in 11 isolates: 10 serotype 19A and 1 serotype 3. CONCLUSIONS TA determination not only helps to diagnose Sp-HUS but also is a predictor for IPD severity. Among hospitalized patients with severe pneumococcal disease, the peak of TA level usually appeared 5-10 days after disease onset.
Collapse
Affiliation(s)
- Yi-Ching Chen
- Division of Pediatric Infectious Disease, Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Hsin-Hang Chen
- Division of Pediatric Infectious Disease, Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | | | - Anna Dudek
- Molecular Infectious Disease Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Mei-Hua Hsu
- Molecular Infectious Disease Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chyi-Liang Chen
- Molecular Infectious Disease Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
| | - Cheng-Hsun Chiu
- Division of Pediatric Infectious Disease, Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan; Molecular Infectious Disease Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
| |
Collapse
|
23
|
Wetzke M, Kopp MV, Seidenberg J, Vogelberg C, Ankermann T, Happle C, Voigt G, Köster H, Illig T, Lex C, Schuster A, Panning M, Barten G, Rohde G, Welte T, Hansen G. PedCAPNETZ - prospective observational study on community acquired pneumonia in children and adolescents. BMC Pulm Med 2019; 19:238. [PMID: 31818288 PMCID: PMC6902429 DOI: 10.1186/s12890-019-1013-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Accepted: 11/26/2019] [Indexed: 12/26/2022] Open
Abstract
Background Pediatric community acquired pneumonia (pedCAP) is one of the leading causes for childhood morbidity accounting for up to 20% of pediatric hospital admissions in high income countries. In spite of its high morbidity, updated epidemiological and pathogen data after introduction of preventive vaccination and novel pathogen screening strategies are limited. Moreover, there is a need for validated recommendations on diagnostic and treatment regimens in pedCAP. Through collection of patient data and analysis of pathogen and host factors in a large sample of unselected pedCAP patients in Germany, we aim to address and substantially improve this situation. Methods pedCAPNETZ is an observational, multi-center study on pedCAP. Thus far, nine study centers in hospitals, outpatient clinics and practices have been initiated and more than 400 patients with radiologically confirmed pneumonia have been enrolled, aiming at a total of 1000 study participants. Employing an online data base, information on disease course, treatment as well as demographical and socioeconomical data is recorded. Patients are followed up until day 90 after enrollment; Comprehensive biosample collection and a central pedCAPNETZ biobank allow for in-depth analyses of pathogen and host factors. Standardized workflows to assure sample logistics and data management in more than fifteen future study centers have been established. Discussion Through comprehensive epidemiological, clinical and biological analyses, pedCAPNETZ fills an important gap in pediatric and infection research. To secure dissemination of the registry, we will raise clinical and scientific awareness at all levels. We aim at participating in decision making processes for guidelines and prevention strategies. Ultimately, we hope the results of the pedCAPNETZ registry will help to improve care and quality of life in pedCAP patients in the future.
Collapse
Affiliation(s)
- Martin Wetzke
- Department of Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Carl-Neuberg-Straße 1, D -, 30625, Hannover, Germany.,German Center for Infection Research (DZIF), Site Hannover-, Braunschweig, Germany.,German Center for Lung Research DZL, Airway Center North (ARCN) Lübeck and Biomedical Research in End-stage and Obstructive Lung Disease Hannover (BREATH), Hannover, Germany
| | - Matthias Volkmar Kopp
- German Center for Lung Research DZL, Airway Center North (ARCN) Lübeck and Biomedical Research in End-stage and Obstructive Lung Disease Hannover (BREATH), Hannover, Germany.,Department of Pediatric Allergy and Pulmonology, Clinic of Pediatrics UKSH, University of Luebeck, Luebeck, Germany
| | - Jürgen Seidenberg
- Department of Pediatric Pneumology and Allergology, Universitätsklinik für Kinder- und Jugendmedizin Oldenburg, Oldenburg, Germany
| | - Christian Vogelberg
- University Children's Hospital, Technical University Dresden, Dresden, Germany
| | - Tobias Ankermann
- Department of Pediatric Pulmonology, Clinic of Pediatrics UKSH, University of Kiel, Kiel, Germany
| | - Christine Happle
- Department of Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Carl-Neuberg-Straße 1, D -, 30625, Hannover, Germany.,German Center for Lung Research DZL, Airway Center North (ARCN) Lübeck and Biomedical Research in End-stage and Obstructive Lung Disease Hannover (BREATH), Hannover, Germany
| | - Gesche Voigt
- German Center for Lung Research DZL, Airway Center North (ARCN) Lübeck and Biomedical Research in End-stage and Obstructive Lung Disease Hannover (BREATH), Hannover, Germany.,Department of Pediatric Allergy and Pulmonology, Clinic of Pediatrics UKSH, University of Luebeck, Luebeck, Germany
| | - Holger Köster
- Department of Pediatric Pneumology and Allergology, Universitätsklinik für Kinder- und Jugendmedizin Oldenburg, Oldenburg, Germany
| | - Thomas Illig
- German Center for Lung Research DZL, Airway Center North (ARCN) Lübeck and Biomedical Research in End-stage and Obstructive Lung Disease Hannover (BREATH), Hannover, Germany.,Hannover Unified Biobank, Hannover Medical School, Hannover, Germany
| | - Christiane Lex
- Department of Pediatric Pulmonology, University of Göttingen, Göttingen, Germany
| | - Antje Schuster
- Department of Pediatric Pulmonology, University of Düsseldorf, Düsseldorf, Germany
| | - Marcus Panning
- Institute of Virology, University of Freiburg, Freiburg, Germany
| | - Grit Barten
- German Center for Lung Research DZL, Airway Center North (ARCN) Lübeck and Biomedical Research in End-stage and Obstructive Lung Disease Hannover (BREATH), Hannover, Germany.,CAPNETZ Foundation, Hannover, Germany
| | - Gernot Rohde
- CAPNETZ Foundation, Hannover, Germany.,Department of Respiratory Medicine, University Hospital Frankfurt, Frankfurt, Germany
| | - Tobias Welte
- German Center for Lung Research DZL, Airway Center North (ARCN) Lübeck and Biomedical Research in End-stage and Obstructive Lung Disease Hannover (BREATH), Hannover, Germany.,CAPNETZ Foundation, Hannover, Germany.,Department of Pulmonary Medicine, German Centre for Lung Research, Hannover Medical School, Hannover, Germany
| | - Gesine Hansen
- Department of Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Carl-Neuberg-Straße 1, D -, 30625, Hannover, Germany. .,German Center for Lung Research DZL, Airway Center North (ARCN) Lübeck and Biomedical Research in End-stage and Obstructive Lung Disease Hannover (BREATH), Hannover, Germany. .,Cluster of Excellence RESIST (EXC 2155), Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | | |
Collapse
|
24
|
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.
Collapse
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
| |
Collapse
|
25
|
Dennison SH, Ask LS, Eriksson M, Granath A, Hertting O, Bennet R, Lindstrand A, Masaba P, Dimitriou P, Stjärne P. Serious complications due to acute rhinosinusitis in children up to five years old in Stockholm, Sweden - Still a challenge in the pneumococcal conjugate vaccine era. Int J Pediatr Otorhinolaryngol 2019; 121:50-54. [PMID: 30861428 DOI: 10.1016/j.ijporl.2019.02.034] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 02/18/2019] [Accepted: 02/20/2019] [Indexed: 01/02/2023]
Abstract
OBJECTIVES The aim of this study was to analyze the rate of admissions, the rate of serious complications (postseptal orbital complications and surgery) and the bacterial etiology of acute rhinosinusitis in hospitalized children under five years old in Stockholm County, eight years after the introduction of the pneumococcal conjugate vaccine (PCV). The secondary aim was to compare this period with the period four years prior to the vaccine's introduction. METHODS This was a population-based, descriptive observational study with retrospectively collected data from 1 July 2008 to 30 June 2016 in Stockholm County. Hospital admissions of children with a discharge diagnosis of rhinosinusitis and related complications were reviewed and compared to the pre-PCV period of 2003-2007. RESULTS A total of 215 children were admitted, for a yearly incidence of 18.8 per 100 000 children (22.8 for boys, 14.6 for girls). Computer tomography-verified postseptal orbital complications occurred in 29 cases (13.5%) and surgery was necessary in nine (4.2%). Pathogens other than Streptococcus pneumoniae were found in the cases with postseptal complication or surgery (Streptococcus pyogenes in four, Haemophilus influenzae in three and Staphylococcus aureus in one case). In comparison to the four years pre-PCV, the incidence of admission decreased from 43.81 to 20.31 and 17.45 per 100 000/year for the two four-year periods after vaccine introduction. The incidence of CT-verified postseptal complication increased slightly from 1.51 to 2.34 and 2.74 per 100 000/year. The incidence of surgeries increased marginally but continued to be very low, from 0.22 to 0.54 and 1.03 per 100 000/year. CONCLUSIONS Complications due to acute rhinosinusitis in children living in Stockholm County continues to be very rare after the introduction of pneumococcal vaccine. Hospitalization has decreased for children under five years old after PCV introduction, but the incidence or postseptal complications and surgery in the same population increased slightly. Predominantly bacteria other than Streptococcus pneumoniae was found. There is a need of larger studies to determine trends, and a need of prospective studies to elucidate the bacterial etiology, of serious complications due to acute rhinosinusitis in children.
Collapse
Affiliation(s)
- S Hultman Dennison
- Department of Otorhinolaryngology, Karolinska University Hospital, Karolinska vägen, 171 76, Solna, Stockholm, Sweden; Department of Clinical Science, Intervention and Technology (CLINTEC), Division of Ear, Nose- and Throat Diseases, Karolinska Institutet, 171 77, Stockholm, Sweden.
| | - L Schollin Ask
- South General Hospital, Sachs' Children and Youth Hospital, Sjukhusbacken 10, 118 83, Stockholm, Sweden; Department of Medicine, Clinical Epidemiology Unit, Karolinska Institutet, 171 77, Stockholm, Sweden
| | - M Eriksson
- Astrid Lindgren Children´s Hospital, Karolinska University Hospital, Department of Pediatric Infectious Diseases, Eugeniavägen 23, 171 64, Solna, Stockholm, Sweden
| | - A Granath
- Department of Otorhinolaryngology, Karolinska University Hospital, Karolinska vägen, 171 76, Solna, Stockholm, Sweden; Department of Clinical Science, Intervention and Technology (CLINTEC), Division of Ear, Nose- and Throat Diseases, Karolinska Institutet, 171 77, Stockholm, Sweden
| | - O Hertting
- Astrid Lindgren Children´s Hospital, Karolinska University Hospital, Department of Pediatric Infectious Diseases, Eugeniavägen 23, 171 64, Solna, Stockholm, Sweden
| | - R Bennet
- Astrid Lindgren Children´s Hospital, Karolinska University Hospital, Department of Pediatric Infectious Diseases, Eugeniavägen 23, 171 64, Solna, Stockholm, Sweden
| | - A Lindstrand
- Department of Public Health Sciences, Division of Global Health, Karolinska Institutet, 171 77, Stockholm, Sweden; Public Health Agency of Sweden, Nobels väg 18, 171 65, Solna, Sweden
| | - P Masaba
- Department of Radiology, Karolinska University Hospital, Karolinska Vägen, 171 76, Solna, Stockholm, Sweden
| | - P Dimitriou
- Department of Radiology, Karolinska University Hospital, Karolinska Vägen, 171 76, Solna, Stockholm, Sweden
| | - P Stjärne
- Department of Otorhinolaryngology, Karolinska University Hospital, Karolinska vägen, 171 76, Solna, Stockholm, Sweden; Department of Clinical Science, Intervention and Technology (CLINTEC), Division of Ear, Nose- and Throat Diseases, Karolinska Institutet, 171 77, Stockholm, Sweden
| |
Collapse
|
26
|
Alvarado S, Cavada G, Villena R, Wilhelm J, Budnik I, Lara C, Salinas X, Azpilcueta N, Valenzuela MT. [Impact of the 10-valent pneumococcal conjugate vaccine on the southern area of Santiago (Chile), 2009-2015Efeito da vacina pneumocócica 10-valente conjugada na região sul de Santiago, Chile, 2009-2015]. Rev Panam Salud Publica 2019; 42:e155. [PMID: 31093183 PMCID: PMC6398315 DOI: 10.26633/rpsp.2018.155] [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] [Received: 06/25/2018] [Accepted: 07/05/2018] [Indexed: 11/25/2022] Open
Abstract
Objetivo El objetivo de este estudio fue evaluar el efecto de la incorporación de la vacuna antineumococica 10-valente (PCV 10) en la incidencia de la enfermedad neumocócica invasora (ENI) y en la neumonía adquirida en la comunidad (NAC) en niños hospitalizados menores de 5 años en el área sur de Santiago de Chile. Métodos Se realizó un estudio ecológico de la incidencia de ENI y NAC en menores de 5 años del área sur de Santiago de Chile de 2009 a 2015. Las fuentes de información utilizadas fueron las de los laboratorios de bacteriología de cuatro hospitales, del Instituto de Salud Pública de Chile (ISP) y los registros de egresos hospitalarios. Resultados Un total de 6 461 casos de NAC y 173 casos de ENI fueron confirmados por el ISP, de los cuales 169 casos fueron diagnosticados en los laboratorios de bacteriología de los hospitales incluidos en el estudio. Al comparar la incidencia de casos de 2010 frente a 2011-2015, la razón de incidencias (RI) de ENI se redujo 10% anualmente (p = 0,026) y la de NAC, 8% en el mismo período (p <0,001). El total de días cama ocupados en el período 2009-2015 fue de 39 565 con una mediana de días cama ocupados entre 4 y 5. Hasta 2012 fallecieron 7 niños y desde entonces no ha habido fallecimientos por estas enfermedades. Conclusiones La incorporación de la vacuna PCV-10 en el Programa Nacional de Inmunizaciones tuvo un efecto positivo, con una reducción significativa de las ENI y NAC y de la ocupación de camas por ENI y evitó casos y muertes.
Collapse
Affiliation(s)
| | - Gabriel Cavada
- Universidad de Chile, Facultad de Medicina, Santiago de Chile, Chile
| | - Rodolfo Villena
- Universidad de Chile, Facultad de Medicina, Santiago de Chile, Chile
| | - Jan Wilhelm
- Hospital Padre Hurtado, Santiago de Chile, Chile
| | - Isolda Budnik
- Complejo asistencial Sótero del Río, Santiago de Chile, Chile
| | - Cristian Lara
- Complejo asistencial Sótero del Río, Santiago de Chile, Chile
| | | | | | - María Teresa Valenzuela
- Universidad de Los Andes, Departamento de Salud Pública y Epidemiología, Santiago de Chile, Chile
| |
Collapse
|
27
|
Rhedin SA, Eklundh A, Ryd-Rinder M, Naucler P, Mårtensson A, Gantelius J, Zenk I, Andersson-Svahn H, Nybond S, Rasti R, Lindh M, Andersson M, Peltola V, Waris M, Alfvén T. Introducing a New Algorithm for Classification of Etiology in Studies on Pediatric Pneumonia: Protocol for the Trial of Respiratory Infections in Children for Enhanced Diagnostics Study. JMIR Res Protoc 2019; 8:e12705. [PMID: 31025954 PMCID: PMC6658235 DOI: 10.2196/12705] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 03/09/2019] [Accepted: 03/24/2019] [Indexed: 01/20/2023] Open
Abstract
Background There is a need to better distinguish viral infections from antibiotic-requiring bacterial infections in children presenting with clinical community-acquired pneumonia (CAP) to assist health care workers in decision making and to improve the rational use of antibiotics. Objective The overall aim of the Trial of Respiratory infections in children for ENhanced Diagnostics (TREND) study is to improve the differential diagnosis of bacterial and viral etiologies in children aged below 5 years with clinical CAP, by evaluating myxovirus resistance protein A (MxA) as a biomarker for viral CAP and by evaluating an existing (multianalyte point-of-care antigen detection test system [mariPOC respi] ArcDia International Oy Ltd.) and a potential future point-of-care test for respiratory pathogens. Methods Children aged 1 to 59 months with clinical CAP as well as healthy, hospital-based, asymptomatic controls will be included at a pediatric emergency hospital in Stockholm, Sweden. Blood (analyzed for MxA and C-reactive protein) and nasopharyngeal samples (analyzed with real-time polymerase chain reaction as the gold standard and antigen-based mariPOC respi test as well as saved for future analyses of a novel recombinase polymerase amplification–based point-of-care test for respiratory pathogens) will be collected. A newly developed algorithm for the classification of CAP etiology will be used as the reference standard. Results A pilot study was performed from June to August 2017. The enrollment of study subjects started in November 2017. Results are expected by the end of 2019. Conclusions The findings from the TREND study can be an important step to improve the management of children with clinical CAP. International Registered Report Identifier (IRRID) DERR1-10.2196/12705
Collapse
Affiliation(s)
- Samuel Arthur Rhedin
- Sachs' Children and Youth Hospital, South General Hospital, Stockholm, Sweden.,Department of Medical Epidemiology and Biostatistics, Karolinska Insitutet, Stockholm, Sweden
| | - Annika Eklundh
- Sachs' Children and Youth Hospital, South General Hospital, Stockholm, Sweden
| | | | - Pontus Naucler
- Division of Infectious Diseases, Department of Medicine, Solna, Karolinska Institutet & Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Andreas Mårtensson
- Department of Women's and Children's Health, International Maternal and Child Health (IMCH), Uppsala University, Uppsala, Sweden
| | - Jesper Gantelius
- Science for Life Laboratory, Division of Proteomics and Nanobiotechnology, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Ingela Zenk
- Sachs' Children and Youth Hospital, South General Hospital, Stockholm, Sweden
| | - Helene Andersson-Svahn
- Science for Life Laboratory, Division of Proteomics and Nanobiotechnology, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Susanna Nybond
- Science for Life Laboratory, Division of Proteomics and Nanobiotechnology, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Reza Rasti
- Sachs' Children and Youth Hospital, South General Hospital, Stockholm, Sweden.,Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Magnus Lindh
- Department of Infectious Diseases, University of Gothenburg, Gothenburg, Sweden
| | - Maria Andersson
- Department of Infectious Diseases, University of Gothenburg, Gothenburg, Sweden
| | - Ville Peltola
- Department of Paediatrics and Adolescent Medicine, Turku University Hospital and University of Turku, Turku, Finland
| | - Matti Waris
- Department of Paediatrics and Adolescent Medicine, Turku University Hospital and University of Turku, Turku, Finland
| | - Tobias Alfvén
- Sachs' Children and Youth Hospital, South General Hospital, Stockholm, Sweden.,Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
28
|
|
29
|
Johansson Kostenniemi U, Palm J, Silfverdal SA. Reductions in otitis and other respiratory tract infections following childhood pneumococcal vaccination. Acta Paediatr 2018; 107:1601-1609. [PMID: 29603797 DOI: 10.1111/apa.14345] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Revised: 03/18/2018] [Accepted: 03/23/2018] [Indexed: 11/27/2022]
Abstract
AIM Streptococcus pneumoniae commonly causes respiratory tract infections including acute otitis media and pneumonia. In this study, we evaluated the impact of general infant pneumococcal vaccination, introduced in Sweden in 2009, on respiratory tract infections. METHODS We studied the incidence of respiratory tract infections and antibiotic consumption in Västerbotten County, Sweden, during 2005-2014 using the County Council's diagnosis register. RESULTS Comparing the prevaccination period of 2005-2008 to 2014, the incidences of all-cause acute otitis media decreased significantly in children aged 0-4 and five years to 17 years, by 41.5% and 20.9%, respectively. In addition, we also noted significant reductions in sinusitis and other upper respiratory tract infections, and some reductions in adults. Antibiotic consumption for upper respiratory tract infections decreased by 37.1%, with the largest decrease occurring in children aged 0-4 years. For pneumonia, the incidence significantly decreased by 28.6% for children aged 0-4 years, with no significant changes in older children or adults. CONCLUSION Pneumococcal vaccination was followed by reduced incidence of upper respiratory tract infections and antibiotic consumption in vaccinated children, with some indications of possible herd immunity. For pneumonia, a major reduction was noted limited to the youngest children.
Collapse
Affiliation(s)
- Urban Johansson Kostenniemi
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden
- Department of Clinical Microbiology, Infectious Diseases, Umeå University, Umeå, Sweden
| | - Jessica Palm
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden
| | | |
Collapse
|
30
|
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.
Collapse
Affiliation(s)
| | | | | | | | - Albert Jan van Hoek
- Public Health England, London, UK.,London School of Hygiene and Tropical Medicine, London, UK
| |
Collapse
|
31
|
Iftikhar M, Junaid N, Lemus M, Mallick ZN, Mina SA, Hannan U, Canner JK, Latif A, Shah SMA. Epidemiology of Primary Ophthalmic Inpatient Admissions in the United States. Am J Ophthalmol 2018; 185:101-109. [PMID: 29101007 DOI: 10.1016/j.ajo.2017.10.014] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 10/20/2017] [Indexed: 01/09/2023]
Abstract
PURPOSE To determine the national estimates, demographics, and costs of inpatient eye care in the United States (US). DESIGN Retrospective cross-sectional study. METHODS National Inpatient Sample (NIS), a representative sample of all US community hospitals, was used to analyze inpatient admissions with a primary ophthalmic diagnosis from 2001 to 2014. National estimates of the most prevalent diagnoses were determined, and descriptive statistics were calculated for demographics and costs. RESULTS From 2001 to 2014, there were an estimated 671 324 inpatient admissions (male patients, 51.6%; mean [standard deviation] age, 44.5 [27.3] years) in the US owing to an ophthalmic disorder-an annual rate of 16 per 100 000 population. The Mid-Atlantic region had the highest rate. Most admissions were owing to nontraumatic disorders (75.3%), classified as emergencies (41.8%), and covered by public insurance (48.9%). The median length of stay was 2 days and mortality was 0.2%. The total inflation-adjusted cost over the 14-year period was $5.9 billion. The most prevalent diagnosis was orbital cellulitis (14.5%), followed by orbital floor fracture (9.6%) and eyelid abscess (6.0%). Most diagnoses were infectious (28.0%) and the majority were attributed to external disease (24.3%). A total of 31.1% of all patients had an ophthalmic procedure, pars plana vitrectomy (4.8%) being the most common one. CONCLUSION There were around 48 000 ophthalmic inpatient admissions in the US costing $421 million every year. Orbital pathology, namely infection and trauma, was the leading cause of admissions. Implementing interventions to decrease the incidence of these conditions may significantly reduce the burden of inpatient ophthalmic care.
Collapse
|
32
|
Cars T, Eriksson I, Granath A, Wettermark B, Hellman J, Norman C, Ternhag A. Antibiotic use and bacterial complications following upper respiratory tract infections: a population-based study. BMJ Open 2017; 7:e016221. [PMID: 29146635 PMCID: PMC5695332 DOI: 10.1136/bmjopen-2017-016221] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To investigate if use of antibiotics was associated with bacterial complications following upper respiratory tract infections (URTIs). DESIGN Ecological time-trend analysis and a prospective cohort study. SETTING Primary, outpatient specialist and inpatient care in Stockholm County, Sweden. All analyses were based on administrative healthcare data on consultations, diagnoses and dispensed antibiotics from January 2006 to January 2016. MAIN OUTCOME MEASURES Ecological time-trend analysis: 10-year trend analyses of the incidence of URTIs, bacterial infections/complications and respiratory antibiotic use. Prospective cohort study: Incidence of bacterial complications following URTIs in antibiotic-exposed and non-exposed patients. RESULTS The utilisation of respiratory tract antibiotics decreased by 22% from 2006 to 2015, but no increased trend for mastoiditis (p=0.0933), peritonsillar abscess (p=0.0544), invasive group A streptococcal disease (p=0.3991), orbital abscess (p=0.9637), extradural and subdural abscesses (p=0.4790) and pansinusitis (p=0.3971) was observed. For meningitis and acute ethmoidal sinusitis, a decrease in the numbers of infections from 2006 to 2015 was observed (p=0.0038 and p=0.0003, respectively), and for retropharyngeal and parapharyngeal abscesses, an increase was observed (p=0.0214). Bacterial complications following URTIs were uncommon in both antibiotic-exposed (less than 1.5 per 10 000 episodes) and non-exposed patients (less than 1.3 per 10 000 episodes) with the exception of peritonsillar abscess after tonsillitis (risk per 10 000 tonsillitis episodes: 32.4 and 41.1 in patients with no antibiotic treatment and patients treated with antibiotics, respectively). CONCLUSIONS Bacterial complications following URTIs are rare, and antibiotics may lack protective effect in preventing bacterial complications. Analyses of routinely collected administrative healthcare data can provide valuable information on the number of URTIs, antibiotic use and bacterial complications to patients, prescribers and policy-makers.
Collapse
Affiliation(s)
- Thomas Cars
- Department of Healthcare Development, Public Healthcare Services Committee, Stockholm County Council, Stockholm, Sweden
| | - Irene Eriksson
- Department of Healthcare Development, Public Healthcare Services Committee, Stockholm County Council, Stockholm, Sweden
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Anna Granath
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Ear, Nose and Throat Clinic, Karolinska University Hospital, Stockholm, Sweden
| | - Björn Wettermark
- Department of Healthcare Development, Public Healthcare Services Committee, Stockholm County Council, Stockholm, Sweden
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | | | | | - Anders Ternhag
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Public Health Agency of Sweden, Solna, Sweden
| |
Collapse
|
33
|
Eriksson M, Nilsson A, Bennet R. Changing diagnosis coding routines may confound the results of longitudinal childhood pneumonia studies. Acta Paediatr 2017; 106:1825-1829. [PMID: 28510985 DOI: 10.1111/apa.13923] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 04/06/2017] [Accepted: 05/12/2017] [Indexed: 12/28/2022]
Abstract
AIM This Swedish study compared the discharge diagnosis codes used for children up to the age of five hospitalised for acute lower respiratory tract infections before and after the introduction of the pneumococcal conjugate vaccine in 2007. METHODS The International Classification of Diseases-10th revision codes were used. We compared the discharge diagnosis codes at the Astrid Lindgren Children's Hospital from 1 July 2005 to 30 June 2007 (n=1,127) and 1 July 2011 to 30 June 2013 (n=1,240) in relation to the diagnostic methods used. RESULTS There was a 54% reduction in the rate of all-cause pneumonia from the first to the second period in children aged 0-1 years, but some of this could have been due to the improved diagnosis of viral infections and us changing the code for respiratory syncytial virus infection from pneumonia to bronchiolitis. The overall rate of acute lower respiratory tract infections was unchanged. CONCLUSION We could not determine how much of the reduction in bacterial pneumonia in children under one was because of the introduction of the pneumococcal conjugate vaccine, based solely on discharge codes. Longitudinal register studies should take changes in diagnosis codes into account.
Collapse
Affiliation(s)
- Margareta Eriksson
- Astrid Lindgren Children's Hospital; Karolinska University Hospital; Stockholm Sweden
| | - Anna Nilsson
- Astrid Lindgren Children's Hospital; Karolinska University Hospital; Stockholm Sweden
| | - Rutger Bennet
- Astrid Lindgren Children's Hospital; Karolinska University Hospital; Stockholm Sweden
| |
Collapse
|
34
|
Gaviria-Agudelo CL, Jordan-Villegas A, Garcia C, McCracken GH. The Effect of 13-Valent Pneumococcal Conjugate Vaccine on the Serotype Distribution and Antibiotic Resistance Profiles in Children With Invasive Pneumococcal Disease. J Pediatric Infect Dis Soc 2017; 6:253-259. [PMID: 26907814 PMCID: PMC7107452 DOI: 10.1093/jpids/piw005] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Accepted: 01/19/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND Invasive pneumococcal disease (IPD) continues to be a significant burden in children despite the implementation of two generations of conjugate vaccines. Serotype replacement by nonvaccine serotypes is reported in multiple areas around the world. This study is a continuation of previous studies and describes the incidence, serotype distribution, and antibiotic resistance pattern of Streptococcus pneumoniae serotypes causing IPD at Children's Medical Center Dallas after introduction of 13-valent pneumococcal conjugate vaccine (PCV13). METHODS Streptococcus pneumoniae isolates from normally sterile sites were collected from January 1, 1999 to June 30, 2014. Demographic and clinical information was extracted for analysis. Incidence of IPD was calculated using inpatient and emergency center admissions to Children's Medical Center of Dallas as the denominator. Isolates were serotyped and penicillin/cefotaxime susceptibilities were determined. Selected nontypeable isolates were further characterized by multilocus sequence typing. A χ2 test and the Cochran-Armitage Trend Test for trend analysis were used to evaluate change in serotype and antibiotic susceptibility patterns over time. RESULTS Comparison of the different study periods showed a significant reduction in the incidence of IPD in PCV13 era compared with prevaccine era and PCV7 era (P < .05). Children younger than 24 months showed the largest reduction of disease incidence. More than 40% of patients with IPD had a documented comorbidity. Cases of pneumonia continued to decrease in the PCV13 era (P < .002). The most common non-PCV13 serotypes after vaccine introduction were as follows: 23B, 6C, 23A, 9N/L, and 12. Penicillin resistance by meningitis breakpoint decreased significantly in the PCV13 era. CONCLUSIONS After introduction of PCV13 in Dallas, incidence of IPD caused by strains contained in the vaccine and penicillin resistance continued to decrease. Serotype replacement phenomena and persistence of PCV7 serotypes were documented. Patients with comorbidities represented a large percentage of patients with IPD. Concerns for geographic variation in serotype replacement phenomena arise from the present study.
Collapse
Affiliation(s)
- Claudia L Gaviria-Agudelo
- Department of Pediatric Infectious Diseases, University of Texas Southwestern, Dallas,,Correspondence: C. L. Gaviria-Agudelo, MD, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390–9063 ()
| | | | - Carla Garcia
- General Pediatrics, Questcare Pediatrics, Dallas, Texas
| | - George H McCracken
- Department of Pediatric Infectious Diseases, University of Texas Southwestern, Dallas,
| |
Collapse
|
35
|
Mackenzie GA, Hill PC, Sahito SM, Jeffries DJ, Hossain I, Bottomley C, Uchendu U, Ameh D, Ndiaye M, Osuorah CD, Adeyemi O, Pathirana J, Olatunji Y, Abatan B, Ahameefula E, Muhammad BS, Fombah AE, Saha D, Mackenzie R, Plumb I, Akano A, Ebruke B, Ideh RC, Kuti B, Githua P, Olutunde E, Ofordile O, Green E, Usuf E, Badji H, Ikumapayi UNA, Manjang A, Salaudeen R, Nsekpong ED, Jarju S, Antonio M, Sambou S, Ceesay L, Lowe-Jallow Y, Sowe D, Jasseh M, Mulholland K, Knoll M, Levine OS, Howie SR, Adegbola RA, Greenwood BM, Corrah T. Impact of the introduction of pneumococcal conjugate vaccination on pneumonia in The Gambia: population-based surveillance and case-control studies. THE LANCET. INFECTIOUS DISEASES 2017; 17:965-973. [PMID: 28601421 PMCID: PMC5589209 DOI: 10.1016/s1473-3099(17)30321-3] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 04/11/2017] [Accepted: 04/25/2017] [Indexed: 12/30/2022]
Abstract
BACKGROUND Pneumococcal conjugate vaccines (PCVs) are used in many low-income countries but their impact on the incidence of pneumonia is unclear. The Gambia introduced PCV7 in August, 2009, and PCV13 in May, 2011. We aimed to measure the impact of the introduction of these vaccines on pneumonia incidence. METHODS We did population-based surveillance and case-control studies. The primary endpoint was WHO-defined radiological pneumonia with pulmonary consolidation. Population-based surveillance was for suspected pneumonia in children aged 2-59 months (minimum age 3 months in the case-control study) between May 12, 2008, and Dec 31, 2015. Surveillance for the impact study was limited to the Basse Health and Demographic Surveillance System (BHDSS), whereas surveillance for the case-control study included both the BHDSS and Fuladu West Health and Demographic Surveillance System. Nurses screened all outpatients and inpatients at all health facilities in the surveillance area using standardised criteria for referral to clinicians in Basse and Bansang. These clinicians recorded clinical findings and applied standardised criteria to identify patients with suspected pneumonia. We compared the incidence of pneumonia during the baseline period (May 12, 2008, to May 11, 2010) and the PCV13 period (Jan 1, 2014, to Dec 31, 2015). We also investigated the effectiveness of PCV13 using case-control methods between Sept 12, 2011, and Sept 31, 2014. Controls were aged 90 days or older, and were eligible to have received at least one dose of PCV13; cases had the same eligibility criteria with the addition of having WHO-defined radiological pneumonia. FINDINGS We investigated 18 833 children with clinical pneumonia and identified 2156 cases of radiological pneumonia. Among children aged 2-11 months, the incidence of radiological pneumonia fell from 21·0 cases per 1000 person-years in the baseline period to 16·2 cases per 1000 person-years (23% decline, 95% CI 7-36) in 2014-15. In the 12-23 month age group, radiological pneumonia decreased from 15·3 to 10·9 cases per 1000 person-years (29% decline, 12-42). In children aged 2-4 years, incidence fell from 5·2 to 4·1 cases per 1000 person-years (22% decline, 1-39). Incidence of all clinical pneumonia increased by 4% (-1 to 8), but hospitalised cases declined by 8% (3-13). Pneumococcal pneumonia declined from 2·9 to 1·2 cases per 1000 person-years (58% decline, 22-77) in children aged 2-11 months and from 2·6 to 0·7 cases per 1000 person-years (75% decline, 47-88) in children aged 12-23 months. Hypoxic pneumonia fell from 13·1 to 5·7 cases per 1000 person-years (57% decline, 42-67) in children aged 2-11 months and from 6·8 to 1·9 cases per 1000 person-years (72% decline, 58-82) in children aged 12-23 months. In the case-control study, the best estimate of the effectiveness of three doses of PCV13 against radiological pneumonia was an adjusted odds ratio of 0·57 (0·30-1·08) in children aged 3-11 months and vaccine effectiveness increased with greater numbers of doses (p=0·026). The analysis in children aged 12 months and older was underpowered because there were few unvaccinated cases and controls. INTERPRETATION The introduction of PCV in The Gambia was associated with a moderate impact on the incidence of radiological pneumonia, a small reduction in cases of hospitalised pneumonia, and substantial reductions of pneumococcal and hypoxic pneumonia in young children. Low-income countries that introduce PCV13 with reasonable coverage can expect modest reductions in hospitalised cases of pneumonia and a marked impact on the incidence of severe childhood pneumonia. FUNDING GAVI's Pneumococcal vaccines Accelerated Development and Introduction Plan, Bill & Melinda Gates Foundation, and UK Medical Research Council.
Collapse
Affiliation(s)
- Grant A Mackenzie
- Medical Research Council Unit, The Gambia, Fajara, The Gambia,Murdoch Childrens Research Institute, Melbourne, VIC, Australia,London School of Hygiene & Tropical Medicine, London, UK,Correspondence to: Dr Grant A Mackenzie, Basse Field Station, MRC The Gambia Unit, PO Box 273, Banjul, The GambiaCorrespondence to: Dr Grant A MackenzieBasse Field StationMRC The Gambia UnitPO Box 273BanjulThe Gambia
| | - Philip C Hill
- Centre for International Health, University of Otago, Dunedin, New Zealand
| | - Shah M Sahito
- Medical Research Council Unit, The Gambia, Fajara, The Gambia
| | | | - Ilias Hossain
- Medical Research Council Unit, The Gambia, Fajara, The Gambia
| | | | - Uchendu Uchendu
- Medical Research Council Unit, The Gambia, Fajara, The Gambia
| | - David Ameh
- Medical Research Council Unit, The Gambia, Fajara, The Gambia
| | - Malick Ndiaye
- Medical Research Council Unit, The Gambia, Fajara, The Gambia
| | | | - Oyedeji Adeyemi
- Medical Research Council Unit, The Gambia, Fajara, The Gambia
| | | | - Yekini Olatunji
- Medical Research Council Unit, The Gambia, Fajara, The Gambia
| | - Bade Abatan
- Medical Research Council Unit, The Gambia, Fajara, The Gambia
| | | | | | | | - Debasish Saha
- Medical Research Council Unit, The Gambia, Fajara, The Gambia
| | | | - Ian Plumb
- Medical Research Council Unit, The Gambia, Fajara, The Gambia
| | | | - Bernard Ebruke
- Medical Research Council Unit, The Gambia, Fajara, The Gambia
| | - Readon C Ideh
- Medical Research Council Unit, The Gambia, Fajara, The Gambia
| | - Bankole Kuti
- Medical Research Council Unit, The Gambia, Fajara, The Gambia
| | - Peter Githua
- Medical Research Council Unit, The Gambia, Fajara, The Gambia
| | | | | | - Edward Green
- Medical Research Council Unit, The Gambia, Fajara, The Gambia
| | - Effua Usuf
- Medical Research Council Unit, The Gambia, Fajara, The Gambia
| | - Henry Badji
- Medical Research Council Unit, The Gambia, Fajara, The Gambia
| | | | - Ahmad Manjang
- Medical Research Council Unit, The Gambia, Fajara, The Gambia
| | | | | | - Sheikh Jarju
- Medical Research Council Unit, The Gambia, Fajara, The Gambia
| | - Martin Antonio
- Medical Research Council Unit, The Gambia, Fajara, The Gambia,Microbiology and Infection Unit, Warwick Medical School, Coventry, UK
| | - Sana Sambou
- Ministry of Health and Social Welfare, Gambia Government, Kotu, The Gambia
| | - Lamin Ceesay
- Ministry of Health and Social Welfare, Gambia Government, Kotu, The Gambia
| | | | - Dawda Sowe
- Ministry of Health and Social Welfare, Gambia Government, Kotu, The Gambia
| | - Momodou Jasseh
- Medical Research Council Unit, The Gambia, Fajara, The Gambia
| | - Kim Mulholland
- Murdoch Childrens Research Institute, Melbourne, VIC, Australia,London School of Hygiene & Tropical Medicine, London, UK
| | - Maria Knoll
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Orin S Levine
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Stephen R Howie
- Medical Research Council Unit, The Gambia, Fajara, The Gambia,Centre for International Health, University of Otago, Dunedin, New Zealand,Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
| | | | | | - Tumani Corrah
- Medical Research Council Unit, The Gambia, Fajara, The Gambia
| |
Collapse
|
36
|
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
| |
Collapse
|
37
|
Impact of ten-valent pneumococcal conjugate vaccine on pneumonia in Finnish children in a nation-wide population-based study. PLoS One 2017; 12:e0172690. [PMID: 28249015 PMCID: PMC5332024 DOI: 10.1371/journal.pone.0172690] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 02/08/2017] [Indexed: 12/29/2022] Open
Abstract
Background The ten-valent pneumococcal conjugate vaccine (PCV10) was introduced into the Finnish National Vaccination Program (NVP) in September 2010 using a 2+1 schedule (3, 5, 12 months). We estimated the direct and indirect effects of PCV10 on pneumonia among children to evaluate the public health impact of the vaccine. Methods We conducted a nation-wide population-based, observational study comparing rates of pneumonia in children before and after the NVP introduction. For the total (direct and indirect) effect, the cohort of vaccine-eligible children (born June 1, 2010 or later) was followed until the end of 2013 (age range 3–42 months). For the indirect effect, a cohort of older children (age range 7–71 months) not eligible for the PCV vaccination was followed from 2011 to 2013. Both cohorts were compared with two season- and age-matched reference cohorts before NVP introduction. Hospitals’ in- and outpatient discharge notifications with ICD-10 diagnoses compatible with pneumonia (J10.0, J11.0, J12-J18, J85.1 or J86) as set by the hospital pediatricians were collected from the national Care Register. The main outcome was hospital-treated primary pneumonia (HTPP), defined as primary diagnosis of pneumonia after in-patient hospitalization. We compared rates of pneumonia in the NVP target and reference cohorts by using Poisson regression models. Results The rate of HTPP episodes was 5.3/1000 person-years in the combined reference cohorts and 4.1/1000 person-years in the target cohort vaccine-eligible children. Compared with the reference cohort, the relative rate reduction in target cohort was 23% (95%CI 18–28) and the absolute reduction 1.3/1000 person-years. In the indirect effect evaluation, we observed continued increase in HTPP incidence until 2011 with a subsequent reduction of 18% (95%CI 10–25) during years 2012 to 2013. Number of empyema diagnoses remained low. Conclusions A substantial decrease in pneumonia rates was observed both among vaccine-eligible children and among older, unvaccinated children after PCV10 introduction.
Collapse
|
38
|
Schollin Ask L, Hultman Dennison S, Stjärne P, Granath A, Srivastava S, Eriksson M, Lindstrand A, Ryd Rinder M. Most preschool children hospitalised for acute rhinosinusitis had orbital complications, more common in the youngest and among boys. Acta Paediatr 2017; 106:268-273. [PMID: 27797408 DOI: 10.1111/apa.13650] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Revised: 09/07/2016] [Accepted: 10/26/2016] [Indexed: 11/29/2022]
Abstract
AIM This study established the incidence of acute rhinosinusitis and related orbital complications in tertiary care in Stockholm County and surveyed the clinical outcomes. METHODS This was a population-based, retrospective, observational study, from July 1, 2003 to June 30, 2007, of the hospital admissions records of 213 children up to five years old, with a diagnosis of sinusitis and related complications. RESULTS Preseptal cellulitis was present in 171 of the 213 admissions, which equated to an incidence of orbital complications due to acute rhinosinusitis of 36 per 100 000 people per year (95% confidence interval 26-49). Postseptal complications occurred in seven cases. The incidence rate ratio for hospitalisation of children less than two years old with rhinosinusitis compared with children aged 2-5 years was 2.8 (95% confidence interval 1.8-4.4). The incidence among boys was 53 per 100 000 people per year and 36 per 100 000 people per year for girls, and the incidence rate ratio was 1.5 (95% confidence interval 1.0-2.3). The most common bacterial finding was Streptococcus pneumoniae. CONCLUSION Most children hospitalised for acute rhinosinusitis had an orbital complication, and this was more common in children under the age of two years and boys. Severe postseptal complications were rare.
Collapse
Affiliation(s)
- L Schollin Ask
- Sach′s Children and Youth Hospital South General Hospital Stockholm Sweden
- Department of Medicine Clinical Epidemiology Unit Karolinska Institutet Stockholm Sweden
| | - S Hultman Dennison
- Department of Otorhinolaryngology Karolinska University Hospital Stockholm Sweden
- Department of Clinical Science, Intervention and Technology (CLINTEC) Division of Ear, Nose‐ and Throat Diseases Karolinska Institutet Stockholm Sweden
| | - P Stjärne
- Department of Otorhinolaryngology Karolinska University Hospital Stockholm Sweden
- Department of Clinical Science, Intervention and Technology (CLINTEC) Division of Ear, Nose‐ and Throat Diseases Karolinska Institutet Stockholm Sweden
| | - A Granath
- Department of Otorhinolaryngology Karolinska University Hospital Stockholm Sweden
- Department of Clinical Science, Intervention and Technology (CLINTEC) Division of Ear, Nose‐ and Throat Diseases Karolinska Institutet Stockholm Sweden
| | - S Srivastava
- Department of Radiology Karolinska University Hospital Stockholm Sweden
| | - M Eriksson
- Astrid Lindgren Children′s Hospital Karolinska University Hospital Stockholm Sweden
| | - A Lindstrand
- Public Health Agency of Sweden Solna Sweden
- Department of Public Health Sciences Division of Global Health Karolinska Institutet Stockholm Sweden
| | - M Ryd Rinder
- Sach′s Children and Youth Hospital South General Hospital Stockholm Sweden
| |
Collapse
|
39
|
Sterky E, Bennet R, Lindstrand A, Eriksson M, Nilsson A. The impact of pneumococcal conjugate vaccine on community-acquired pneumonia hospitalizations in children with comorbidity. Eur J Pediatr 2017; 176:337-342. [PMID: 28070670 PMCID: PMC5321702 DOI: 10.1007/s00431-016-2843-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 12/20/2016] [Accepted: 12/23/2016] [Indexed: 01/04/2023]
Abstract
UNLABELLED The burden of community-acquired pneumonia (CAP) in high-income countries is still significant. The introduction of pneumococcal conjugate vaccines (PCV) has reduced the overall need for hospitalization for CAP. However, it is not clear whether children with underlying disease also have benefitted from the PCV immunization programme. Children 0 to <5 years of age hospitalized with CAP and discharged with an ICD-10 code of J13-J18.9 between November 1, 2005, and April 30, 2007 (pre-vaccination period), and November 1, 2010, and April 30, 2012 (post-vaccination period), were eligible for this study. Data on hospitalization and discharge diagnoses were retrieved from the Hospital Registry. In addition, chart review was performed in 50% of the patients. Our result confirmed a decrease in hospitalization rate for CAP in the PCV13 period. Chart review revealed that half of the patients had underlying comorbidity and these children had more severe symptoms and required longer hospital stay. Intensive care was provided to less than 10% of the children and mostly for children with an underlying neurological disease. CONCLUSIONS We show that all children have benefitted from the reduction of CAP hospitalization after introduction of PCV. Our finding emphasizes the importance of children with chronic diseases receiving adequate vaccinations that may protect from lower respiratory diseases. What is known? • Community-acquired pneumonia is a leading infectious cause of hospitalizations and death among children <5 years of age globally • Pneumococcal conjugate vaccine reduces the hospitalizations of all-cause pneumonia What is new? • We show that also children with underlying comorbidities have benefitted from PCV immunization with a reduction of CAP hospitalization • We show that approximately half of all children hospitalized with CAP also have underlying comorbidities.
Collapse
Affiliation(s)
- Ellinor Sterky
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
| | | | - Ann Lindstrand
- Paediatric Infectious Diseases Unit, Paediatric Emergency Department, Astrid Lindgren’s Children Hospital, Stockholm, Sweden
| | | | - Anna Nilsson
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden. .,Childhood Cancer Research Unit Q6:05, Astrid Lindgren Childrens Hospital, Stockholm, Sweden.
| |
Collapse
|
40
|
Ben-Shimol S, Givon-Lavi N, Greenberg D, Dagan R. Pneumococcal nasopharyngeal carriage in children <5 years of age visiting the pediatric emergency room in relation to PCV7 and PCV13 introduction in southern Israel. Hum Vaccin Immunother 2016; 12:268-76. [PMID: 26430921 DOI: 10.1080/21645515.2015.1095414] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
The 7-valent and the 13-valent pneumococcal conjugate vaccines (PCV7 and PCV13, respectively) were introduced to the Israeli National Immunization plan in July 2009 and November 2010, respectively. Our aim was to assess pneumococcal conjugate vaccines (PCVs) uptake and dynamics in serotype-specific pneumococcal nasopharyngeal (NP) carriage in children <5 years old in southern Israel, during the immediate 5 y following PCV introduction. This was an ongoing, prospective, population-based, active surveillance, from July 2009 through December 2014. PCVs uptake and NP cultures were obtained daily from children seen at the Pediatric Emergency Room for any reason. Overall, 10,702 vaccine status and 7,610 NP swabs were obtained. Both PCV7 and PCV13 uptake were high, reaching ˜90% by July 2012 and December 2013, respectively. All-pneumococcal carriage rates significantly declined by 10%, from 54.3% in the early-PCV7 period, to 49.1% in the PCV13 impact period. The respective declines for PCV7, 6A and additional PCV13 serotypes carriage rates were 76%, 90% and 66%. In contrast, non-PCV13 serotypes carriage rates increased significantly throughout the study by 71%. All-pneumococcal carriage rates in children <12 months old decreased significantly by 15%, with similar trends observed in other age groups. Initially, all-pneumococcal carriage rates were 45.7%, and 61.9% in Jewish and Bedouin children, respectively (P < 0.001), with a significant 17% reduction throughout the study observed only in Bedouins. While early carriage rates were higher in unvaccinated children compared to vaccinated children, PCV impact on carriage were similar in both groups. In conclusion, a relatively moderate decline in pneumococcal carriage rates, facilitated by a substantial decrease of vaccine-serotypes and increase of non-vaccine serotypes was observed in the immediate period following PCVs introduction in southern Israel.
Collapse
Affiliation(s)
- Shalom Ben-Shimol
- a Pediatric Infectious Disease Unit; Ben-Gurion University of the Negev and Soroka University Medical Center ; Beer-Sheva , Israel
| | - Noga Givon-Lavi
- a Pediatric Infectious Disease Unit; Ben-Gurion University of the Negev and Soroka University Medical Center ; Beer-Sheva , Israel
| | - David Greenberg
- a Pediatric Infectious Disease Unit; Ben-Gurion University of the Negev and Soroka University Medical Center ; Beer-Sheva , Israel
| | - Ron Dagan
- a Pediatric Infectious Disease Unit; Ben-Gurion University of the Negev and Soroka University Medical Center ; Beer-Sheva , Israel
| |
Collapse
|
41
|
Parker DM, Schang L, Wasserman JR, Viles WD, Bevan G, Goodman DC. Variation in Utilization and Need for Tympanostomy Tubes across England and New England. J Pediatr 2016; 179:178-184.e4. [PMID: 27697331 PMCID: PMC5530588 DOI: 10.1016/j.jpeds.2016.08.093] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 07/25/2016] [Accepted: 08/26/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To compare rates of typmanostomy tube insertions for otitis media with effusion with estimates of need in 2 countries. STUDY DESIGN This cross-sectional analysis used all-payer claims to calculate rates of tympanostomy tube insertions for insured children ages 2-8 years (2007-2010) across pediatric surgical areas (PSA) for Northern New England (NNE; Maine, Vermont, and New Hampshire) and the English National Health Service Primary Care Trusts (PCT). Rates were compared with expected rates estimated using a Monte Carlo simulation model that integrates clinical guidelines and published probabilities of the incidence and course of otitis media with effusion. RESULTS Observed rates of tympanostomy tube placement varied >30-fold across English PCT (N = 150) and >3-fold across NNE PSA (N = 30). At a 25 dB hearing threshold, the overall difference in observed to expected tympanostomy tubes provided was -3.41 per 1000 child-years in England and -0.01 per 1000 child-years in NNE. Observed incidence of insertion was less than expected in 143 of 151 PCT, and was higher than expected in one-half of the PSA. Using a 20 dB hearing threshold, there were fewer tube insertions than expected in all but 2 England and 7 NNE areas. There was an inverse relationship between estimated need and observed tube insertion rates. CONCLUSIONS Regional variations in observed tympanostomy tube insertion rates are unlikely to be due to differences in need and suggest overall underuse in England and both overuse and underuse in NNE.
Collapse
|
42
|
Varghese L, Mungall B, Zhang XH, Hoet B. Response to Wu et al. - Cost-effectiveness analysis of infant pneumococcal vaccination in Malaysia and Hong Kong. Hum Vaccin Immunother 2016; 12:2675-2680. [PMID: 27459265 PMCID: PMC5084998 DOI: 10.1080/21645515.2016.1192738] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A recently published paper that assessed the comparative cost-effectiveness of the 2 pneumococcal conjugate vaccines (PCVs) in Malaysia and Hong Kong reported that the 13-valent PCV vaccine (PCV13) is a better choice compared to the 10-valent pneumococcal non-typeable Haemophilus influenzae protein D conjugate vaccine (PHiD-CV or PCV10) from both a payer and societal perspective as well as under various scenarios. However, the analysis relied on a large number of assumptions that were either erroneous or did not take into account the most recent body of evidence available. A rigorous evaluation of the underlying assumptions is necessary to present a fair and balanced analysis for decision-making.
Collapse
|
43
|
Littorin N, Ahl J, Uddén F, Resman F, Riesbeck K. Reduction of Streptococcus pneumoniae in upper respiratory tract cultures and a decreased incidence of related acute otitis media following introduction of childhood pneumococcal conjugate vaccines in a Swedish county. BMC Infect Dis 2016; 16:407. [PMID: 27514843 PMCID: PMC4982432 DOI: 10.1186/s12879-016-1750-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Accepted: 08/03/2016] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND The effect of pneumococcal conjugate vaccines (PCV) on invasive pneumococcal disease is frequently reported, but the impact on upper respiratory tract infections in a clinical setting is less documented. Our aim in this 5-year observational study was to investigate serotype changes in a large number of Streptococcus pneumoniae upper respiratory tract isolates following sequential introduction of PCV7 and pneumococcal Haemophilus influenza protein D conjugate vaccine (PHiD-CV10) in a Swedish county. METHODS All bacterial isolates from the upper respiratory tract (nasopharynx, sinus or middle ear fluid) from patients with respiratory tract infections referred to a clinical microbiology laboratory prior to (2 years 2007-2008; n = 1566) and after introduction of PCV (3 years 2011-2013; n = 1707) were prospectively collected. Microbiological findings were compared between the two periods, and information from clinical referrals was recorded in order to explore changes in incidence of pneumococcal acute otitis media (AOM). RESULTS Pneumococcal serotypes covered by PHiD-CV10 decreased from 45 to 12 % prior to and after immunization (p < 0.001), respectively. Despite non-PHiD-CV10 serotypes increased from 49 to 80 %, a significant decline of 35 % in the absolute incidence of pneumocococal isolates (p < 0.001) was observed. Finally, the frequency of complicated AOM caused by S. pneumoniae decreased by 32 % (p < 0.001). CONCLUSIONS After introduction of PCV in 2009, we have observed a significantly decreased number of pneumococcal isolates in the upper respiratory tract, a shift to non-PHiD-CV10 serotypes, and a reduction of complicated AOM. Our findings may have implications for future vaccine design.
Collapse
Affiliation(s)
- Nils Littorin
- Clinical Microbiology, Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Jonas Ahl
- Clinical Microbiology, Department of Translational Medicine, Lund University, Malmö, Sweden.,Infectious Diseases Research Unit, Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Fabian Uddén
- Clinical Microbiology, Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Fredrik Resman
- Clinical Microbiology, Department of Translational Medicine, Lund University, Malmö, Sweden.,Infectious Diseases Research Unit, Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Kristian Riesbeck
- Clinical Microbiology, Department of Translational Medicine, Lund University, Malmö, Sweden.
| |
Collapse
|
44
|
Lindstrand A, Galanis I, Darenberg J, Morfeldt E, Naucler P, Blennow M, Alfvén T, Henriques-Normark B, Örtqvist Å. Unaltered pneumococcal carriage prevalence due to expansion of non-vaccine types of low invasive potential 8years after vaccine introduction in Stockholm, Sweden. Vaccine 2016; 34:4565-4571. [PMID: 27473304 DOI: 10.1016/j.vaccine.2016.07.031] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2016] [Revised: 07/03/2016] [Accepted: 07/18/2016] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To evaluate the carriage prevalence, serotype distribution, and antibiotic resistance for pneumococcal carriage isolates collected 4-8years after introduction of pneumococcal conjugate vaccines (PCVs) in Stockholm, Sweden, and to identify risk factors for carriage and calculate the invasive disease potential for emerging serotypes. METHODS Nasopharyngeal aspirates were collected from 3024 children aged 0-<5years at regular visits at 23 Child Health Centers in Stockholm County in 2011-2015, and from 787 parents in 2014-2015. The invasive disease potential was calculated for serotypes using invasive disease isolates from 824 patients of all ages identified in the Stockholm County during the same time period as the carriage isolates. RESULTS A total carriage prevalence of 30% did not change during the study period. Non-vaccine types (NVT) dominated (94% by 2015) and the most common serotypes in descending order were 11A, 23B, 35F and 21. Risk factors for carriage were: age ⩾3months-<3years, having siblings, attending day-care and having travelled abroad the last 3months. Antibiotic resistance remained low. The invasive disease potential was high for NVT 8, 9N, 12F, and 22F, while low for a majority of emerging NVTs in carriage. CONCLUSION The carriage prevalence remained the same 4-8years after vaccine introduction, but serotype replacement became almost complete. A majority of emerging NVTs in carriage showed a low invasive disease potential. Carriage studies are an important complement to invasive disease surveillance to understand the full effect of PCV vaccine programs.
Collapse
Affiliation(s)
- Ann Lindstrand
- The Public Health Agency Sweden, SE-171 82, Solna, Sweden; Department of Public Health Sciences, Karolinska Institutet, SE-171 77 Stockholm, Sweden.
| | - Ilias Galanis
- The Public Health Agency Sweden, SE-171 82, Solna, Sweden
| | | | - Eva Morfeldt
- The Public Health Agency Sweden, SE-171 82, Solna, Sweden
| | - Pontus Naucler
- Department of Medicine, Unit of Infectious Diseases, Karolinska University Hospital, SE-171 76, Solna, Sweden
| | - Margareta Blennow
- Sachs' Children and Youth Hospital, South General Hospital, SE-118 83 Stockholm, Sweden; Department of Clinical Sciences and Education, Karolinska Institutet, SE-171 77 Stockholm, Sweden
| | - Tobias Alfvén
- Department of Public Health Sciences, Karolinska Institutet, SE-171 77 Stockholm, Sweden; Sachs' Children and Youth Hospital, South General Hospital, SE-118 83 Stockholm, Sweden
| | - Birgitta Henriques-Normark
- The Public Health Agency Sweden, SE-171 82, Solna, Sweden; Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, SE-171 77 Stockholm, Sweden; Department of Clinical Microbiology, Karolinska University Hospital, SE-171 76 Stockholm, Sweden
| | - Åke Örtqvist
- Department of Medicine, Unit of Infectious Diseases, Karolinska University Hospital, SE-171 76, Solna, Sweden; Department of Communicable Disease Control and Prevention, SE-118 83, Stockholm County Council, Sweden
| |
Collapse
|
45
|
Abstract
Management of common infections and optimal use of antimicrobial agents are presented, highlighting new evidence from the medical literature that enlightens practice. Primary therapy of staphylococcal skin abscesses is drainage. Patients who have a large abscess (>5 cm), cellulitis or mixed abscess-cellulitis likely would benefit from additional antibiotic therapy. When choosing an antibiotic for outpatient management, the patient, pathogen and in vitro drug susceptibility as well as tolerability, bioavailability and safety characteristics of antibiotics should be considered. Management of recurrent staphylococcal skin and soft tissue infections is vexing. Focus is best placed on reducing density of the organism on the patient's skin and in the environment, and optimizing a healthy skin barrier. With attention to adherence and optimal dosing, acute uncomplicated osteomyelitis can be managed with early transition from parenteral to oral therapy and with a 3-4 week total course of therapy. Doxycycline should be prescribed when indicated for a child of any age. Its use is not associated with dental staining. Azithromycin should be prescribed for infants when indicated, whilst being alert to an associated ≥2-fold excess risk of pyloric stenosis with use under 6 weeks of age. Beyond the neonatal period, acyclovir is more safely dosed by body surface area (not to exceed 500 mg/m(2)/dose) than by weight. In addition to the concern of antimicrobial resistance, unnecessary use of antibiotics should be avoided because of potential later metabolic effects, thought to be due to perturbation of the host's microbiome.
Collapse
Affiliation(s)
- Sarah S Long
- Drexel University College of Medicine, Chief, Section of Infectious Diseases, St. Christopher's Hospital for Children, Philadelphia, PA, USA.
| |
Collapse
|
46
|
Wu CT, Lee HY, Chen CL. A Near-fatal Case of Invasive Pneumococcal Disease in a Vaccinated Child. Pediatr Neonatol 2016; 57:76-8. [PMID: 26126815 DOI: 10.1016/j.pedneo.2015.03.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Revised: 03/08/2015] [Accepted: 03/25/2015] [Indexed: 11/18/2022] Open
Affiliation(s)
- Chang-Teng Wu
- Division of Pediatric General Medicine, Department of Pediatrics, Chang Gung Children's Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan; Graduate Institute of Clinical Medical Sciences, Chang Gung University College of Medicine, Taoyuan, Taiwan.
| | - Hao-Yuan Lee
- Division of Pediatric General Medicine, Department of Pediatrics, Chang Gung Children's Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan; Graduate Institute of Clinical Medical Sciences, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Chyi-Liang Chen
- Molecular Infectious Disease Research Center, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| |
Collapse
|
47
|
Galanis I, Lindstrand A, Darenberg J, Browall S, Nannapaneni P, Sjöström K, Morfeldt E, Naucler P, Blennow M, Örtqvist Å, Henriques-Normark B. Effects of PCV7 and PCV13 on invasive pneumococcal disease and carriage in Stockholm, Sweden. Eur Respir J 2016; 47:1208-18. [PMID: 26797033 PMCID: PMC4819883 DOI: 10.1183/13993003.01451-2015] [Citation(s) in RCA: 113] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 12/01/2015] [Indexed: 01/05/2023]
Abstract
The effects of pneumococcal conjugated vaccines (PCVs) need to be investigated. In Stockholm County, Sweden, PCV7 was introduced in the childhood immunisation programme in 2007 and changed to PCV13 in 2010.Over 90% of all invasive isolates during 2005-2014 (n=2336) and carriage isolates, 260 before and 647 after vaccine introduction, were characterised by serotyping, molecular typing and antibiotic susceptibility, and serotype diversity was calculated. Clinical information was collected for children and adults with invasive pneumococcal disease (IPD).The IPD incidence decreased post-PCV7, but not post-PCV13, in vaccinated children. Beneficial herd effects were seen in older children and adults, but not in the elderly. The herd protection was more pronounced post-PCV7 than post-PCV13. PCV7 serotypes decreased. IPD caused by PCV13 serotypes 3 and 19A increased post-PCV7. Post-PCV13, serotypes 6A and 19A, but not serotype 3, decreased. The serotype distribution changed in carriage and IPD to nonvaccine types, also in nonvaccinated populations. Expansion of non-PCV13 serotypes was largest following PCV13 introduction. Serotype diversity increased and nonvaccine clones emerged, such as CC433 (serotype 22F) in IPD and CC62 (serotype 11A) in carriage. In young children, meningitis, septicaemia and severe rhinosinusitis, but not bacteraemic pneumonia, decreased.Pneumococcal vaccination leads to expansion of new or minor serotypes/clones, also in nonvaccinated populations.
Collapse
Affiliation(s)
- Ilias Galanis
- Public Health Agency of Sweden, Solna, Sweden These authors contributed equally to this article
| | - Ann Lindstrand
- Public Health Agency of Sweden, Solna, Sweden Dept of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden These authors contributed equally to this article
| | - Jessica Darenberg
- Public Health Agency of Sweden, Solna, Sweden These authors contributed equally to this article
| | - Sarah Browall
- Dept of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden Dept of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden
| | - Priyanka Nannapaneni
- Dept of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden
| | | | | | - Pontus Naucler
- Dept of Medicine Solna, Infectious Diseases Unit, Karolinska Institutet, Stockholm, Sweden Dept of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Margareta Blennow
- Sachs' Children's Hospital, South General Hospital, Stockholm, Sweden Dept of Clinical Sciences and Education, Karolinska Institutet, Stockholm, Sweden
| | - Åke Örtqvist
- Dept of Medicine Solna, Infectious Diseases Unit, Karolinska Institutet, Stockholm, Sweden Dept of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden These authors contributed equally to this article
| | - Birgitta Henriques-Normark
- Public Health Agency of Sweden, Solna, Sweden Dept of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden Dept of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden These authors contributed equally to this article
| |
Collapse
|
48
|
Isturiz RE, Schmoele-Thoma B, Scott DA, Jodar L, Webber C, Sings HL, Paradiso P. Pneumococcal conjugate vaccine use in adults. Expert Rev Vaccines 2015; 15:279-93. [PMID: 26651847 DOI: 10.1586/14760584.2016.1132171] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Streptococcus pneumoniae is a leading cause of illness and death in adults. A polysaccharide vaccine has been available for over 30 years, but despite significant use, the public health impact of this vaccine has been limited. The 13-valent pneumococcal conjugate vaccine (PCV13) has been licensed by the US Food and Drug Administration and other international regulatory authorities with the assumption that induction of a T cell-dependent immune response and noninferior immunogenicity to vaccine antigens when compared with the polysaccharide vaccine would be important to satisfy a significant unmet medical need. PCV13 efficacy against vaccine-type pneumococcal community-acquired pneumonia was confirmed in a large randomized controlled trial in older adults and its use is now increasingly recommended globally.
Collapse
Affiliation(s)
| | | | - Daniel A Scott
- c Pfizer Vaccine Clinical Research , Pearl River , NY , USA
| | | | - Chris Webber
- d Pfizer Vaccine Clinical Research , Maidenhead , UK
| | | | - Peter Paradiso
- e Paradiso Biologics Consulting, LLC , Radnor , PA , USA
| |
Collapse
|
49
|
Abstract
Acute bacterial sinusitis (ABS) is a common complication of a simple upper respiratory infection. Acute bacterial sinusitis and an upper respiratory infection, however, have different management plans. This article will help clinicians establish when a diagnosis of ABS can be made based on the latest guidelines from the American Academy of Pediatrics. Also covered will be the pathophysiology of ABS, the role of diagnostic imaging, the recognition of complications of ABS, and treatment options.
Collapse
|
50
|
Additive impact of pneumococcal conjugate vaccines on pneumonia and empyema hospital admissions in England. J Infect 2015; 71:428-36. [PMID: 26159503 DOI: 10.1016/j.jinf.2015.06.011] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Revised: 06/12/2015] [Accepted: 06/27/2015] [Indexed: 12/31/2022]
Abstract
OBJECTIVES A wider spectrum 13-valent pneumococcal vaccine (PCV13) replaced PCV7 in the child immunization schedule in England from 2010. We assessed the additional impact of PCV13 over PCV7 on all-cause pneumonia and empyema admissions. METHODS We extracted Hospital Episode Statistics data from 2001 to 2014 on all-cause pneumonia (ICD-10 codes J12-18) and empyema admissions (J86.0, J86.9) for children <16 years in England. Trend analysis and rate ratios (RR) were calculated comparing the Pre-vaccine era to September 2006, the PCV7 era and the PCV13 era from April 2010. RESULTS Annual hospital admissions for pneumonia and empyema were increasing in the Pre-vaccine era peaking in 2005 at 15,733 pneumonia and 382 empyema cases (158.6 and 3.9 per 100,000 children, respectively). These rates fell following PCV7 introduction in 2006 but began to climb soon afterwards until PCV13 was introduced. By 2013, admission rates for pneumonia and empyema were 102.2 and 1.9 per 100,000 children, respectively. We found no added benefit of PCV13 over PCV7 on pneumonia admissions following PCV13 introduction but there was a significant decrease in empyema admissions in children aged <2 years (RR 0.58; 95% CI 0.34-0.99). CONCLUSIONS Additional serotypes covered by PCV13 may be more important in the aetiology of empyema and invasive disease than as a cause of uncomplicated pneumonia.
Collapse
|