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Nhantumbo AA, Comé CE, Maholela PI, Munguambe AM, da Costa P, Mott M, Cunha GR, Chambal L, Dias C, Cantarelli VV, Gudo ES. Etiology of meningitis among adults in three quaternary hospitals in Mozambique, 2016-2017: The role of HIV. PLoS One 2022; 17:e0267949. [PMID: 35544535 PMCID: PMC9094547 DOI: 10.1371/journal.pone.0267949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 04/19/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Meningitis remains an important cause of morbi-mortality in adults in sub-Saharan Africa. Data on the etiological investigation of meningitis in adults in Mozambique is limited and most studies were conducted in southern Mozambique. Identification of the etiology of meningitis in adults are crucial to guide prevention and treatments strategies. In this study, we determine the burden of fungal and bacterial meningitis among adults at the three largest hospitals in Mozambique. METHOD We performed analysis of data from the routine sentinel surveillance system for meningitis in Mozambique from January 2016 to December 2017. Cerebrospinal fluid (CSF) samples were collected from eligible adults (≥18 years old) who met World Health Organization (WHO) case definition criteria for Meningitis. All samples were tested by cryptococcal antigen (CrAg) lateral flow assay (LFA), culture and triplex real-time polymerase chain reaction (qPCR) assay and all patients were tested for human immunodeficiency virus (HIV) using the national algorithm for HIV testing. RESULTS Retrospective analysis of 1501 CSF samples from adults clinically suspected of meningitis revealed that 10.5% (158/1501) were positive for bacterial and fungal meningitis. Of these 158 confirmed cases, the proportion of Cryptococcal meningitis and pneumococcal meningitis was38.6% (95% CI: 31.0% to 46.7%) and 36.7% (95% CI: 29.2% to 44.7%), respectively. The other bacterial agents of meningitis identified include Neisseria meningitidis (8.9%; 14/158), Escherichia coli (6.3%; 10/158), Haemophilus influenzae (5.1%; 8/158) and S. aureus (4.4%; 7/158), which represent (24.7%; 39/158) of the total confirmed cases. CONCLUSION Altogether, our findings show a high burden of Cryptococcal meningitis among adults in Mozambique, especially in people living with HIV, followed by pneumococcal meningitis. Our findings suggest that rollout of CrAg Lateral Flow Assay in the health system in Mozambique for early detection of cryptococcus neoformans is necessary to improve overall patient care.
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Affiliation(s)
- Aquino Albino Nhantumbo
- Laboratório de Bacteriologia e Patógenos de Alto Risco, Instituto Nacional de Saúde, Ministério da Saúde, Maputo, Mozambique
| | - Charlotte Elizabeth Comé
- Laboratório de Bacteriologia e Patógenos de Alto Risco, Instituto Nacional de Saúde, Ministério da Saúde, Maputo, Mozambique
| | | | - Alcides Moniz Munguambe
- Laboratório de Bacteriologia e Patógenos de Alto Risco, Instituto Nacional de Saúde, Ministério da Saúde, Maputo, Mozambique
| | - Paulino da Costa
- Unidade de Gestão de Dados, Instituto Nacional de Saúde, Ministério da Saúde, Maputo, Mozambique
| | - Mariana Mott
- Universidade Federal de Ciências de Saúde de Porto Algre (UFCSPA), Porto Alegre, Brazil
| | - Gabriella Rosa Cunha
- Universidade Federal de Ciências de Saúde de Porto Algre (UFCSPA), Porto Alegre, Brazil
| | - Lúcia Chambal
- Departamento de Medicina at the Hospital Central de Maputo, Ministério da Saúde, Maputo, Mozambique
| | - Cícero Dias
- Universidade Federal de Ciências de Saúde de Porto Algre (UFCSPA), Porto Alegre, Brazil
| | - Vlademir Vicente Cantarelli
- Universidade Federal de Ciências de Saúde de Porto Algre (UFCSPA), Porto Alegre, Brazil
- Universidade Feevale, Novo Hamburgo, RS, Brazil
| | - Eduardo Samo Gudo
- Instituto Nacional de Saúde, Ministério da Saúde, Maputo, Mozambique
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Bacigalupo A, Metafuni E, Amato V, Marquez Algaba E, Pagano L. Reducing infectious complications after allogeneic stem cell transplant. Expert Rev Hematol 2020; 13:1235-1251. [PMID: 32996342 DOI: 10.1080/17474086.2020.1831382] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Infections remain a significant problem, in patients undergoing an allogeneic hematopoietic stem-cell transplant (HSCT) and efforts have been made over the years, to reduce the incidence, morbidity and mortality of infectious complications. AREAS COVERED This manuscript is focused on the epidemiology, risk factors and prevention of infections after allogeneic HSCT. A systematic literature review was performed using the PubMed database, between November 2019 and January 2020, with the following MeSH terms: stem-cell transplantation, infection, fungal, bacterial, viral, prophylaxis, vaccines, prevention. The authors reviewed all the publications, and following a common revision, a summary report was made and results were divided in three sections: bacterial, fungal and viral infections. EXPERT OPINION Different infections occur in the early, intermediate and late post-transplant period, due to distinct risk factors. Improved diagnostic techniques, pre-emtive therapy and better prophylaxis of immunologic complications, have reduced the morbidity and mortality of infections. The role of the gut microbiota is under careful scrutiny and may further help us to identify high-risk patients.
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Affiliation(s)
- Andrea Bacigalupo
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli- IRCCS , Rome, Italy
| | - Elisabetta Metafuni
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli- IRCCS , Rome, Italy
| | - Viviana Amato
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli- IRCCS , Rome, Italy
| | - Ester Marquez Algaba
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona , Barcelona, Spain
| | - Livio Pagano
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli- IRCCS , Rome, Italy.,Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica Del Sacro Cuore , Rome, Italy
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Thindwa D, Pinsent A, Ojal J, Gallagher KE, French N, Flasche S. Vaccine strategies to reduce the burden of pneumococcal disease in HIV-infected adults in Africa. Expert Rev Vaccines 2020; 19:1085-1092. [PMID: 33269987 PMCID: PMC8315211 DOI: 10.1080/14760584.2020.1843435] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Streptococcus pneumoniae is the leading cause of invasive bacterial disease, globally. Despite antiretroviral therapy, adults infected with human immunodeficiency virus (HIV) are also at high risk of pneumococcal carriage and disease. Pneumococcal conjugate vaccines (PCVs) provide effective protection against vaccine serotype (VT) carriage and disease in children, and have been introduced worldwide, including most HIV-affected low- and middle-income countries. Unlike high-income countries, the circulation of VT persists in the PCV era in some low-income countries and results in a continued high burden of pneumococcal disease in HIV-infected adults. Moreover, no routine vaccination that directly protects HIV-infected adults in such settings has been implemented. AREAS COVERED Nonsystematic review on the pneumococcal burden in HIV-infected adults and vaccine strategies to reduce this burden. EXPERT OPINION We propose and discuss the relative merit of changing the infant PCV program to use (1a) a two prime plus booster dose schedule, (1b) a two prime plus booster dose schedule with an additional booster dose at school entry, to directly vaccinate (2a) HIV-infected adults or vaccinating (2b) HIV-infected pregnant women for direct protection, with added indirect protection to the high-risk neonates. We identify key knowledge gaps for such an evaluation and propose strategies to overcome them.
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Affiliation(s)
- Deus Thindwa
- Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, UK,Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK,Malawi Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi,CONTACT Deus Thindwa Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, WC1E 7HT, London, United Kingdom
| | - Amy Pinsent
- Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, UK,Aquarius Population Health, London, UK
| | - John Ojal
- Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, UK,Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK,Epidemiology and Demography Department, KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine, Coast, Kilifi, Kenya
| | - Katherine E Gallagher
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Neil French
- Malawi Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi,Institute of Infection and Global Health, Department of Clinical Infection, Microbiology, and Immunology, University of Liverpool, Liverpool, UK
| | - Stefan Flasche
- Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, UK,Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
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Chilson E, Scott DA, Schmoele-Thoma B, Watson W, Moran MM, Isturiz R. Immunogenicity and safety of the 13-valent pneumococcal conjugate vaccine in patients with immunocompromising conditions: a review of available evidence. Hum Vaccin Immunother 2020; 16:2758-2772. [PMID: 32530360 PMCID: PMC7746253 DOI: 10.1080/21645515.2020.1735224] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 02/21/2020] [Indexed: 02/06/2023] Open
Abstract
Immunocompromising conditions increase the risk of invasive pneumococcal disease (IPD). Vaccine uptake in patients with these conditions may be low in part because of concerns about decreased immunogenicity and safety in these high-risk groups. We conducted a literature search to identify publications describing antibody responses to 13-valent pneumococcal conjugate vaccine (PCV13) in immunocompromised individuals recommended for PCV13 vaccination by the US Advisory Committee on Immunization Practices (ACIP). This review summarizes immunogenicity data from 30 publications regarding the use of PCV13 comprising 2406 individuals considered at high risk for IPD by the ACIP. Although antibody responses to PCV13 in individuals with immunocompromising and high-risk conditions were variable and generally lower compared with healthy controls, the vaccine was immunogenic and was largely well tolerated. Based on these findings, concerns regarding immunogenicity and safety of PCV13 are not supported and should not be barriers to vaccination in high-risk populations.
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Affiliation(s)
- Erica Chilson
- Vaccine Medical Development & Scientific/Clinical Affairs, Pfizer Inc, Collegeville, PA, USA
| | - Daniel A. Scott
- Vaccine Clinical Research and Development, Pfizer Inc, Collegeville, PA, USA
| | | | - Wendy Watson
- Vaccine Clinical Research and Development, Pfizer Inc, Collegeville, PA, USA
| | - Mary M. Moran
- Vaccine Medical Development & Scientific/Clinical Affairs, Pfizer Inc, Collegeville, PA, USA
| | - Raul Isturiz
- Vaccine Medical Development & Scientific/Clinical Affairs, Pfizer Inc, Collegeville, PA, USA
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5
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Lindholm DE, Licciardi PV, Ratu FT, Kim Mulholland E, Nguyen CD, Russell FM. Predictors of antibody persistence to the 7-valent pneumococcal conjugate vaccine in healthy Fijian infants at 12 months of age. Vaccine 2020; 38:5095-5099. [PMID: 32580918 DOI: 10.1016/j.vaccine.2020.06.025] [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: 03/02/2020] [Revised: 06/05/2020] [Accepted: 06/08/2020] [Indexed: 10/24/2022]
Abstract
Little is known about the predictors of antibody persistence to pneumococcal conjugate vaccines (PCV) in the context of reduced dose schedules. In Fiji, an RCT investigated 0, 1, 2 and 3 dose schedules of 7-valent PCV administered at 6, 10 and 14 weeks of age in 364 healthy infants. This study was a post-hoc analysis of the predictors of poor antibody persistence at 12 months, prior to a booster, using univariable and multivariable analyses. The strongest predictors of poor antibody persistence as measured by serotype-specific immunoglobulin G (IgG) and opsonophagocytosis (OI) assays were being of Indigenous Fijian ethnicity (IgG: adjusted odds ratio (aOR) 3.43, p < 0.001; OI: aOR 1.96, p = 0.013) and receipt of fewer than 3 doses of PCV. These findings may help to identify which children may be at an increased risk of pneumococcal disease in the context of reduced dose primary series PCV schedules.
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Affiliation(s)
- Daniel E Lindholm
- Infection and Immunity, Murdoch Children's Research Institute (MCRI), Melbourne, Australia; Centre for International Child Health, Department of Paediatrics, The University of Melbourne, Australia
| | - Paul V Licciardi
- Infection and Immunity, Murdoch Children's Research Institute (MCRI), Melbourne, Australia; Centre for International Child Health, Department of Paediatrics, The University of Melbourne, Australia
| | - Felisita T Ratu
- Infection and Immunity, Murdoch Children's Research Institute (MCRI), Melbourne, Australia
| | - E Kim Mulholland
- Infection and Immunity, Murdoch Children's Research Institute (MCRI), Melbourne, Australia; London School of Hygiene and Tropical Medicine, London, UK
| | - Cattram D Nguyen
- Infection and Immunity, Murdoch Children's Research Institute (MCRI), Melbourne, Australia; Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Melbourne, Australia
| | - Fiona M Russell
- Infection and Immunity, Murdoch Children's Research Institute (MCRI), Melbourne, Australia; Centre for International Child Health, Department of Paediatrics, The University of Melbourne, Australia.
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Garmpi A, Damaskos C, Garmpis N, Patsouras A, Savvanis S, Gravvanis N, Diamantis E. Pneumococcal Vaccination Strategies Among HIV-infected Adult Patients: A Review of the Literature. In Vivo 2020; 33:1425-1430. [PMID: 31471388 DOI: 10.21873/invivo.11620] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 07/21/2019] [Accepted: 07/22/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Streptococcus pneumoniae is the leading cause of bacterial pneumonia and an important cause of invasive disease. Despite the antiretroviral therapies, adults infected with human immunodeficiency virus (HIV) are at particular risk for invasive pneumococcal disease (IPD). The purpose of this study was to report the efficacy of the strategies currently being used in pneumococcal vaccination for HIV-infected adults. MATERIALS AND METHODS A literature search was performed through electronic databases, for original articles in English, from years 2000 to 2019. Clinical trials controlled or randomized, and cohort studies were included. RESULTS While 23-valent pneumococcal polysaccharide vaccine (PPV23) is recommended for immunocompromised patients, it has been reported that it is less suitable for HIV-infected patients. Recent guidelines have added pneumococcal conjugate vaccine (PCV) to the list of recommended vaccines. CONCLUSION Further studies are needed to determine the optimal vaccines and intervals for subsequent revaccinations during the lifetime.
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Affiliation(s)
- Anna Garmpi
- Internal Medicine Department, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Christos Damaskos
- Second Department of Propedeutic Surgery, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Garmpis
- Second Department of Propedeutic Surgery, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Spyridon Savvanis
- Department of Internal Medicine, Elpis General Hospital, Athens, Greece
| | | | - Evangelos Diamantis
- Department of Endocrinology and Diabetes Center, G. Gennimatas General Hospital, Athens, Greece
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7
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Lee YJ, Huang YT, Kim SJ, Kerpelev M, Gonzalez V, Kaltsas A, Papanicolaou G. Trends in Invasive Pneumococcal Disease in Cancer Patients After the Introduction of 7-valent Pneumococcal Conjugate Vaccine: A 20-year Longitudinal Study at a Major Urban Cancer Center. Clin Infect Dis 2019; 66:244-253. [PMID: 29020313 DOI: 10.1093/cid/cix739] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 08/11/2017] [Indexed: 12/11/2022] Open
Abstract
Background Rates of invasive pneumococcal disease (IPD) declined since routine childhood immunization with the 7-valent pneumococcal conjugate vaccine (PCV7) in 2000. We studied the impact of PCV7 on the incidence of IPD in cancer patients. Methods This was a retrospective analysis of adult and pediatric patients treated at Memorial Sloan Kettering Cancer Center from 1992 to 2012. Recovery of Streptococcus pneumoniae from a sterile site defined IPD. IPD incidence was calculated as cases per 1,000 unique patient-visits per year (UPV). IPD incidence was calculated for the periods: "before PCV7" (1992-2000), "after PCV7" (2001-2010) and "after PCV13" (2011-2012). Results Of 343 IPD cases, 165, 155, and 23 cases occurred "before PCV7," "after PCV7" and "after PCV13" respectively. The IPD incidence declined from 0.43 "before PCV7" to 0.17 "after PCV7" (95% confidence interval [CI]: 0.33-0.46, P < .001) and 0.11 "after PCV13" (95% CI: 0.42-0.96, P = .004). Adults with hematologic malignancies and children had the highest incidence. In patients 1-4 years old, the incidence declined from 11.2 "before PCV7" to 2.38 "after PCV7" (79% decrease, 95% CI: 0.1-0.4, P < .001). In patients with hematologic malignancies, the incidence declined from 2.55 "before PCV7" to 0.92 "after PCV7" (64% decrease, 95% CI: 0.27-0.47, P < .001). Conclusions The incidence of IPD among cancer patients sharply declined after introduction of PCV7; especially in high risk groups. The decline in adults suggests an indirect effect from PCV7 childhood vaccination.
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Affiliation(s)
- Yeon Joo Lee
- Infectious Disease Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York.,Department of Medicine, Weill Cornell Medical College, Cornell University, New York
| | - Yao-Ting Huang
- Infectious Disease Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York
| | - Seong Jin Kim
- Infectious Disease Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York
| | - Marina Kerpelev
- Information Systems, Memorial Sloan Kettering Cancer Center, New York
| | - Victoria Gonzalez
- Infectious Disease Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York
| | - Anna Kaltsas
- Infectious Disease Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York.,Department of Medicine, Weill Cornell Medical College, Cornell University, New York
| | - Genovefa Papanicolaou
- Infectious Disease Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York.,Department of Medicine, Weill Cornell Medical College, Cornell University, New York
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Hung TY, Kotecha RS, Blyth CC, Steed SK, Thornton RB, Ryan AL, Cole CH, Richmond PC. Immunogenicity and safety of single-dose, 13-valent pneumococcal conjugate vaccine in pediatric and adolescent oncology patients. Cancer 2017; 123:4215-4223. [PMID: 28696530 DOI: 10.1002/cncr.30764] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2016] [Revised: 03/02/2017] [Accepted: 04/12/2017] [Indexed: 11/12/2022]
Abstract
BACKGROUND Children receiving immunosuppressive treatment for cancer are at high risk for invasive pneumococcal disease. The 13-valent pneumococcal conjugate vaccine (PCV13) can prevent pneumococcal disease in healthy children; however, there is an absence of literature regarding the benefit of PCV13 in immunocompromised children with cancer. METHODS A prospective, open-label cohort study recruited children between ages 1 and 18 years who were receiving active immunosuppressive therapy (AIT) or were within 12 months after completing immunosuppressive therapy (CIT). Blood samples were taken before and 4 weeks after the administration of single-dose PCV13. Serotype-specific immunoglobulin G antibody titers were measured, and titers ≥0.35 μg/mL were considered protective. Solicited side effects were recorded in a 7-day diary after vaccination. RESULTS Eighty-five children were recruited. At baseline, ≤50% had protective antibody titers against Streptococcus pneumoniae for 10 serotypes in the AIT group and for 8 serotypes in the CIT group. Postvaccination, ≥70% had protective antibody titers for 9 and 11 serotypes in the AIT and CIT groups, respectively. Both groups had comparable responses to PCV7 serotypes, whereas a significantly higher proportion in the CIT group achieved protective antibody titers to PCV13 serotypes. There was a low rate of serious adverse events (3.5%). CONCLUSIONS A single-dose of PCV13 is safe and immunogenic in children diagnosed with cancer. All children who are receiving therapy for cancer should receive a single dose of PCV13 as soon as possible after diagnosis, regardless of prior PCV exposure. The current data support the recommendation for an additional dose of PCV13 after the completion of immunosuppressive therapy to provide additional protection against invasive pneumococcal disease. Cancer 2017;123:4215-4223. © 2017 American Cancer Society.
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Affiliation(s)
- Te-Yu Hung
- Department of Haematology and Oncology, Princess Margaret Hospital for Children, Perth, Western Australia, Australia.,School of Paediatrics and Child Health, University of Western Australia, Perth, Western Australia, Australia
| | - Rishi S Kotecha
- Department of Haematology and Oncology, Princess Margaret Hospital for Children, Perth, Western Australia, Australia.,School of Paediatrics and Child Health, University of Western Australia, Perth, Western Australia, Australia.,Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
| | - Christopher C Blyth
- School of Paediatrics and Child Health, University of Western Australia, Perth, Western Australia, Australia.,Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia.,PathWest Laboratory Medicine WA, Perth, Western Australia, Australia.,Department of Infectious Diseases, Princess Margaret Hospital for Children, Perth, Western Australia, Australia
| | - Sarah K Steed
- Department of Haematology and Oncology, Princess Margaret Hospital for Children, Perth, Western Australia, Australia
| | - Ruth B Thornton
- School of Paediatrics and Child Health, University of Western Australia, Perth, Western Australia, Australia.,Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
| | - Anne L Ryan
- Department of Haematology and Oncology, Princess Margaret Hospital for Children, Perth, Western Australia, Australia
| | - Catherine H Cole
- Department of Haematology and Oncology, Princess Margaret Hospital for Children, Perth, Western Australia, Australia.,School of Paediatrics and Child Health, University of Western Australia, Perth, Western Australia, Australia.,Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia.,PathWest Laboratory Medicine WA, Perth, Western Australia, Australia
| | - Peter C Richmond
- School of Paediatrics and Child Health, University of Western Australia, Perth, Western Australia, Australia.,Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia.,Department of Paediatrics, Princess Margaret Hospital for Children, Perth, Western Australia, Australia
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Teh BW, Harrison SJ, Slavin MA, Worth LJ. Epidemiology of bloodstream infections in patients with myeloma receiving current era therapy. Eur J Haematol 2016; 98:149-153. [PMID: 27717026 DOI: 10.1111/ejh.12813] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2016] [Indexed: 01/12/2023]
Abstract
BACKGROUND Bloodstream infections (BSIs) are a significant complication of treatment for multiple myeloma (MM). The objective of this study was to define the epidemiology of BSI with current era MM treatment regimens, including immunomodulatory drugs, proteasome inhibitors and autologous haematopoietic stem cell transplantation (ASCT). METHODS Clinical and microbiology records of patients with MM diagnosed between 2008 and 2012 were reviewed using a standardised tool to capture patient demographics, myeloma characteristics and BSI characteristics (type, severity, outcomes). Conditional risk set modelling was used to determine clinical predictors of BSI. RESULTS Of 199 studied patients, 71 (35.6%) had confirmed BSI (98 infection episodes). Peak incidence was 65.1 infections/100 patient-years at 4-6 months following MM diagnosis with a late peak at 64-66 months. Gram-positive pathogens were responsible for the majority (54.5%) of infections during induction, whilst gram-negative pathogens were responsible for the majority (57.7%) of infections during disease progression. Overall, Escherichia coli was the most frequently identified pathogen. Streptococcus pneumoniae comprised 6.1% of all BSIs at a median of 7.5 months following MM diagnosis. Highest rates of ICU admission (23.1%) and mortality (11.5%) were seen with BSIs in patients with progressive disease. Recent ASCT was independently associated with increased BSI risk (HR 3.09, P = 0.05). CONCLUSIONS Treatment of progressive disease is a high-risk period for infection, evidenced by high proportions of BSI due to gram-negative pathogens and S. pneumoniae. Targeted evaluation of preventative strategies (prophylaxis, vaccination) to reduce morbidity and mortality during this period is required.
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Affiliation(s)
- Benjamin W Teh
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Parkville, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, Peter MacCallum Cancer Centre, Parkville, Victoria, Australia
| | - Simon J Harrison
- Sir Peter MacCallum Department of Oncology, Peter MacCallum Cancer Centre, Parkville, Victoria, Australia.,Department of Haematology, Peter MacCallum Cancer Centre, Parkville, Victoria, Australia
| | - Monica A Slavin
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Parkville, Victoria, Australia.,Department of Medicine, University of Melbourne, Parkville, Victoria, Australia.,Victorian Infectious Diseases Service, Doherty Institute for Infection and Immunity, Parkville, Victoria, Australia
| | - Leon J Worth
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Parkville, Victoria, Australia.,Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
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Berical AC, Harris D, Dela Cruz CS, Possick JD. Pneumococcal Vaccination Strategies. An Update and Perspective. Ann Am Thorac Soc 2016; 13:933-44. [PMID: 27088424 PMCID: PMC5461988 DOI: 10.1513/annalsats.201511-778fr] [Citation(s) in RCA: 96] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 02/23/2016] [Indexed: 11/20/2022] Open
Abstract
Streptococcus pneumoniae is an important global pathogen that causes a wide range of clinical disease in children and adults. Pneumococcal pneumonia is by far the common presentation of noninvasive and invasive pneumococcal disease and affects the young, the elderly, and the immunocompromised disproportionately. Patients with chronic pulmonary diseases are also at higher risk for pneumococcal infections. Substantial progress over the century has been made in the understanding of pneumococcal immunobiology and the prevention of invasive pneumococcal disease through vaccination. Currently, two pneumococcal vaccines are available for individuals at risk of pneumococcal disease: the 23-valent pneumococcal polysaccharide vaccine (PPV23) and the 13-valent pneumococcal protein-conjugate vaccine (PCV13). The goal of pneumococcal vaccination is to stimulate effective antipneumococcal antibody and mucosal immunity response and immunological memory. Vaccination of infants and young children with pneumococcal conjugate vaccine has led to significant decrease in nasal carriage rates and pneumococcal disease in all age groups. Recent pneumococcal vaccine indication and schedule recommendations on the basis of age and risk factors are outlined in this Focused Review. As new pneumococcal vaccine recommendations are being followed, continued efforts are needed to address the vaccine efficacy in the waning immunity of the ever-aging population, the implementation of vaccines using two different vaccines under very specific schedules and their real world clinical and cost effectiveness, and the development of next generation pneumococcal vaccines.
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Affiliation(s)
- Andrew C Berical
- Section of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Drew Harris
- Section of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Charles S Dela Cruz
- Section of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Jennifer D Possick
- Section of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
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Ocampo TF, Le T, Matthews PE, Okulicz JF. 23-Valent Pneumococcal Polysaccharide Vaccine Uptake in the United States Air Force HIV Program. J Int Assoc Provid AIDS Care 2016; 15:286-90. [PMID: 27215560 DOI: 10.1177/2325957416649667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Streptococcus pneumoniae infection is a predominant cause of bacterial infection in HIV-infected individuals. However, reported rates of pneumococcal vaccination with 23-valent polysaccharide vaccine (PPV23) are variable. We evaluated uptake of PPV23 in patients diagnosed with HIV between 1996 and 2012 (n = 507) in the United States Air Force, a centralized HIV program with free access to care including vaccines and medications. A total of 411 (81.1%) patients received at least 1 PPV23 dose. The PPV23 vaccination within 1 year of diagnosis was greater for those diagnosed between 2004 and 2012 (n = 184, 86%) compared with 1996 to 2003 (n = 104, 56.5%; P < .001). For those with ≥6 years of follow-up, receipt of a second recommended PPV23 dose was greater for those diagnosed between 1996 and 2003 (n = 52, 57.8%) compared with 2004 to 2012 (n = 9, 28.1%; P = .004). Although first PPV23 vaccination was high in recent years, process improvement efforts are underway to overcome barriers and improve uptake of pneumococcal vaccines in our program.
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Affiliation(s)
- Thad F Ocampo
- Allergy/Immunology Service, Wilford Hall Ambulatory Surgical Center, Lackland Air Force Base, San Antonio, TX, USA
| | - Tuan Le
- Joint Trauma System, United States Army Institute of Surgical Research, San Antonio Military Medical Center, Fort Sam Houston, San Antonio, TX, USA
| | - Peter E Matthews
- Infectious Disease Service, Mike O'Callaghan Federal Hospital, Nellis AFB, NV, USA
| | - Jason F Okulicz
- Infectious Disease Service, San Antonio Military Medical Center, Fort Sam Houston, San Antonio, TX, USA
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Functional anti-polysaccharide IgG titres induced by unadjuvanted pneumococcal-conjugate vaccine when delivered by microprojection-based skin patch. Vaccine 2015; 33:6675-83. [PMID: 26518398 DOI: 10.1016/j.vaccine.2015.10.081] [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] [Received: 06/26/2015] [Revised: 09/14/2015] [Accepted: 10/19/2015] [Indexed: 11/21/2022]
Abstract
Adequate access to effective and affordable vaccines is essential for the prevention of mortality due to infectious disease. Pneumonia--a consequence of Streptococcus pneumoniae infection--is the world's leading cause of death in children aged under 5 years. The development of a needle-free, thermostable pneumococcal-conjugate vaccine (PCV) could revolutionise the field by reducing cold-chain and delivery constraints. Skin patches have been used to deliver a range of vaccines, with some inducing significantly higher vaccine-specific immunogenicity than needle-injected controls in pre-clinical models, though they have yet to be used to deliver a PCV. We dry-coated a licensed PCV onto a microprojection-based patch (the Nanopatch) and delivered it to mouse skin. We analysed resulting anti-polysaccharide IgG responses. With and without adjuvant, anti-polysaccharide IgG titres induced by Nanopatch immunisation were significantly higher than dose-matched intramuscular controls. These improved responses were primarily obtained against pneumococcal serotypes 4 and 14. Importantly, capsule-specific IgG correlated with functionality in an opsonophagocytic killing assay. We demonstrate enhanced anti-PCV immunogenicity when delivered by Nanopatch over intramuscular injection. As the first study of a PCV delivered by a skin vaccination technology, this report indicates the potential for reduced costs and greater global distribution of such a vaccine.
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Lee KY, Tsai MS, Kuo KC, Tsai JC, Sun HY, Cheng AC, Chang SY, Lee CH, Hung CC. Pneumococcal vaccination among HIV-infected adult patients in the era of combination antiretroviral therapy. Hum Vaccin Immunother 2015; 10:3700-10. [PMID: 25483681 DOI: 10.4161/hv.32247] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
HIV-infected patients remain at higher risk for pneumococcal disease than the general population despite immune reconstitution and suppression of HIV replication with combination antiretroviral therapy. Vaccination with 23-valent pneumococcal polysaccharide vaccine (PPV23) composed of T-cell-independent antigens has been recommended to reduce the risk of pneumococcal disease in HIV-infected adults. However, given the heterogeneity of study design, execution and subjects enrolled, studies examining serological responses to PPV23 yielded conflicting results and observational studies of clinical effectiveness only provided moderate evidence to support the routine use of PPV23 in HIV-infected adults. Pneumococcal conjugate vaccine (PCV), with conjugation of the capsular polysaccharide to a protein carrier, is more immunogenic than PPV23 and has been demonstrated to protect against pneumococcal disease in HIV-infected children and recurrent invasive pneumococcal disease in HIV-infected adolescents and adults. Guidelines have recently been revised to recommend that HIV-infected patients aged 19 y or older receive one dose of 13-valent pneumococcal conjugate vaccine (PCV13) followed by a booster vaccination with PPV23. In this paper, we review the studies using different vaccination strategies to improve immunogenicity among HIV-infected adult patients.
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Key Words
- ACIP, Advisory Committee on Immunization Practices
- AIDS
- ART, antiretroviral therapy
- DHHS, Department of Health and Human Services
- EACS, European AIDS Clinical Society
- ELISA, enzyme-linked immunosorbent assay
- GMT, geometric mean titer
- IPD, invasive pneumococcal disease
- NA, not available
- OPA, opsonophagocytic activity
- PCV, pneumococcal conjugate vaccine
- PCV13, 13-valent pneumococcal conjugate vaccine
- PCV7, 7-valent pneumococcal conjugate vccine
- PPV, pneumococcal polysaccharide vaccine
- PPV23, 23-valent pneumococcal polysaccharide vaccine
- PVL, plasma HIV RNA load
- Streptococcus pneumoniae
- TLR, toll-like receptor
- cART, combination antiretroviral therapy
- immunodeficiency
- immunogenicity
- invasive pneumococcal disease
- pneumococcal conjugate vaccine
- pneumococcal disease
- pneumococcal polysaccharide vaccine
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Affiliation(s)
- Kuan-Yeh Lee
- a Department of Internal Medicine ; National Taiwan University Hospital; Hsin-Chu Branch ; Hsin-Chu , Taiwan
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14
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Fletcher MA, Balmer P, Bonnet E, Dartois N. PCVs in individuals at increased risk of pneumococcal disease: a literature review. Expert Rev Vaccines 2015; 14:975-1030. [DOI: 10.1586/14760584.2015.1037743] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Ludwig E, Mészner Z. [Prevention of Streptococcus pneumoniae (pneumococcal) infections in adults]. Orv Hetil 2015; 155:1996-2004. [PMID: 25481502 DOI: 10.1556/oh.2014.30070] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Infections caused by Streptococcus pneumoniae (pneumococcus) are still meaning a serious health problem, about 40% of community acquired pneumonia (CAP) is due to pneumococcal bacteria in adults requiring hospitalization. The incidence and mortality rate of pneumococcal infections is increasing in the population above 50 years of age. Certain congenital and acquired immunocompromised conditions make the individual susceptible for pneumococcal infection and other chronic comorbidities should be considered as a risk factor as well, such as liver and renal diseases, COPD, diabetes mellitus. Lethality of severe pneumococcal infections with bacteraemia still remains about 12% despite adequate antimicrobial therapy in the past 60 years. Underestimation of pneumococcal infections is mainly due to the low sensitivity of diagnostic tools and underuse of bacteriological laboratory confirmation methods. 13-valent pneumococcal conjugate vaccine (PCV-13) became available recently beyond the 23-valent polysacharide vaccine (PPV-23) which has been using for a long time.The indication and proper administration of the two vaccines are based on international recommendations and vaccination guideline published by National Centre for Epidemiology (NCE):Pneumococcal vaccination is recommended for: Every person above 50 years of age. Patients of all ages with chronic diseases who are susceptible for severe pneumococcal infections: respiratory (COPD), heart, renal, liver disease, diabetes, or patients under immunsuppressive treatment. Smokers regardless of age and comorbidities. Cochlear implants, cranial-injured patients. Patients with asplenia.Recommendation for administration of the two different vaccines:Adults who have not been immunized previously against pneumococcal disease must be vaccinated with a dose of 13-valent pneumococcal conjugate vaccine first. This protection could be extended with administration of 23-valent pneumococcal polysaccharide vaccine at least two month later. Adults who have been immunized previously, but above 65 years of age, with a 23-valent polysaccharide vaccine are recommended to get one dose of conjugate vaccine at least one year later. Adults who have been immunized previously, but under 65 years of age, with a 23-valent polysaccharide vaccine are recommended to get one dose of conjugate vaccine at least one year later. After a minimal interval of two months one dose of 23-valent pneumococcal polysaccharide vaccine is recommended if at least 5 years have elapsed since their previous PPSV23 dose. Vaccination of immuncompromised patients (malignancy, transplantation, etc.) and patients with asplenia should be defined by vaccinology specialists. Pneumococcal vaccines may be administered concommitantly or any interval with other vaccines.
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Affiliation(s)
- Endre Ludwig
- Egyesített Szent István és Szent László Kórház, Semmelweis Egyetem Általános Orvostudományi Kar, Infektológiai Tanszéki Csoport Budapest Albert Flórián út 5-7. 1097
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