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The Cost-Effectiveness of 13-Valent Pneumococcal Conjugate Vaccine in Seven Chinese Cities. Vaccines (Basel) 2021; 9:vaccines9111368. [PMID: 34835299 PMCID: PMC8624982 DOI: 10.3390/vaccines9111368] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 11/11/2021] [Accepted: 11/13/2021] [Indexed: 11/16/2022] Open
Abstract
Objective: This study estimates the cost-effectiveness of vaccination with the 13-valent pneumococcal conjugate vaccine (PCV13) among infants in Beijing, Shanghai, Shenzhen, Chengdu, Karamay, Qingdao, and Suzhou. Methods: A previously published cost-effectiveness model comparing vaccination with PCV13 to no vaccination was localized to the included Chinese cities. A systematic literature review was undertaken to identify age-specific incidence rates for pneumococcal bacteremia, pneumococcal meningitis, pneumonia, and otitis media (AOM). Age-specific direct medical costs of treating the included pneumococcal diseases were taken from the Chinese Health Insurance Association database. The base case analysis evaluated vaccine efficacy using direct effect and indirect effects (DE+ IDE). A subsequent scenario analysis evaluated the model outcomes if only DE was considered. A vaccination rate of 70% was used. The model reported outcomes over a one-year period after it was assumed the vaccine effects had reached a steady state (5–7 years after vaccine introduction) to include the direct and indirect effects of vaccination. Health outcomes were discounted at 5% during the steady-state period. Results: Vaccination with PCV13 was cost-effective in the base case analysis for all included cities with the incremental cost-effectiveness ratio (ICER) ranging from 1145 CNY(Shenzhen) to 15,422 CNY (Qingdao) per quality-adjusted life-year (QALY) gained. PCV13 was the dominant strategy in Shanghai with lower incremental costs and higher incremental QALYs. PCV13 remained cost-effective in the DE-only analysis with all ICERs falling below a cost-effectiveness threshold of three times GDP per capita in each city. Conclusions: Vaccination with PCV13 was a cost-effective strategy in the analyzed cities for both the DE-only and DE + IDE analyses. PCV13 became very cost-effective when a vaccination rate was reached where IDE is observed.
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Su WJ, Chuang PH, Chang LY, Lo HY, Chiang CS, Wang ET, Yang CH. Application of the screening and indirect cohort methods to evaluate the effectiveness of pneumococcal vaccination program in adults 75 years and older in Taiwan. BMC Infect Dis 2021; 21:45. [PMID: 33423657 PMCID: PMC7798272 DOI: 10.1186/s12879-020-05721-0] [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: 04/22/2020] [Accepted: 12/18/2020] [Indexed: 11/23/2022] Open
Abstract
Background The Taiwanese national 23-valent pneumococcal polysaccharide vaccine (PPV23) program in adults ≥75 years of age and the 13-valent pneumococcal conjugate vaccine (PCV13) program for children were implemented in 2008 and 2013, respectively. In this study we evaluated PPV23 vaccine effectiveness (PPV23VE) in the elderly, with regard to both direct protection from the vaccine itself and the indirect protection conferred by PCV13 immunization in children. Methods The incidence of invasive pneumococcal disease (IPD) in Taiwan from July 2008 to June 2016 was collected from IPD surveillance data. A comparison of IPD incidence with a nationwide vaccination registry allowed an estimation of PPV23VE by the screening and indirect cohort methods. Results The incidence of IPD in adults ≥75 years of age ranged from 13.9 per 100,000 inhabitants during the period July 2008–June 2013 to 10.4 per 100,000 inhabitants between July 2013 and June 2016 (relative risk [RR]: 0.75; 95% confidence interval [95% CI]: 0.67–0.85). According to the screening method, PPV23VE against death within 30 days of IPD onset, all IPD, and PPV23-serotype IPD was 32.5% (95% CI: 17.5–44.7%), 33.9% (95% CI: 25.2–41.5%) and 43.4% (95% CI: 34.4–51.2%), respectively. PPV23VE with the indirect cohort method was 39.0% (95% CI: 15.5–55.9%) for all PPV23 serotypes and 71.5% (95% CI: 44.2–85.4%) for 11 serotypes included in PPV23 but not in PCV13. During the period July 2008–June 2012, PPV23VE against PPV23-serotype IPD was 55.1% (95% CI: 27.2–72.3%). Conclusions PPV23 is able to prevent IPD and 30-day fatality in adults 75 years of age and older due to a combination of direct effects from PPV23 and indirect effects from PCV13. It might confer higher protection against PPV23-serotype IPD before the introduction of PCV13 program in children. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-020-05721-0.
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Affiliation(s)
- Wei-Ju Su
- Division of Acute Infectious Diseases, Centers for Disease Control, Ministry of Health and Welfare, 6, Linsen South Road, Taipei, 100, Taiwan, Republic of China.,Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan, Republic of China
| | - Pei-Hung Chuang
- Center for Prevention and Treatment of Occupational Injury and Diseases, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China.,Division of Clinical Toxicology and Occupational Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China
| | - Luan-Yin Chang
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan, Republic of China
| | - Hsiu-Yun Lo
- Division of Acute Infectious Diseases, Centers for Disease Control, Ministry of Health and Welfare, 6, Linsen South Road, Taipei, 100, Taiwan, Republic of China
| | - Chuen-Sheue Chiang
- Division of Acute Infectious Diseases, Centers for Disease Control, Ministry of Health and Welfare, 6, Linsen South Road, Taipei, 100, Taiwan, Republic of China
| | - Ez-Tzu Wang
- Division of Acute Infectious Diseases, Centers for Disease Control, Ministry of Health and Welfare, 6, Linsen South Road, Taipei, 100, Taiwan, Republic of China
| | - Chin-Hui Yang
- Division of Acute Infectious Diseases, Centers for Disease Control, Ministry of Health and Welfare, 6, Linsen South Road, Taipei, 100, Taiwan, Republic of China.
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Ladhani SN, Andrews N, Ramsay ME. Summary of evidence to reduce the two-dose infant priming schedule to a single dose of the 13-valent pneumococcal conjugate vaccine in the national immunisation programme in the UK. THE LANCET. INFECTIOUS DISEASES 2020; 21:e93-e102. [PMID: 33129426 DOI: 10.1016/s1473-3099(20)30492-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 04/23/2020] [Accepted: 04/30/2020] [Indexed: 11/28/2022]
Abstract
Pneumococcal conjugate vaccines (PCVs) are highly effective in preventing invasive and non-invasive pneumococcal infections in all age groups through a combination of direct and indirect protection. In many industrialised countries with established PCV programmes, the maximum benefit of the PCV programme has already been achieved, with most cases now due to non-PCV serotypes. On Jan 1, 2020, the UK changed its childhood pneumococcal immunisation programme from a two-dose infant priming schedule with the 13-valent PCV at 8 and 16 weeks after birth, to a single priming dose at 12 weeks after birth, while retaining the 12-month booster. This decision was made after reviewing the evidence from surveillance data, clinical trials, epidemiological analyses, vaccine effectiveness estimates, and modelling studies to support the reduced schedule. In this Review, we summarise the epidemiology of pneumococcal disease in the UK, the evidence supporting the decision to implement a reduced schedule, and the national and global implications of the proposed schedule.
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Affiliation(s)
- Shamez N Ladhani
- Immunisation and Countermeasures Division, Public Health England, Colindale, London, UK; Paediatric Infectious Diseases Research Group, St George's University of London, Cranmer Terrace, London, UK.
| | - Nick Andrews
- Statistics, Modelling, and Economics Department, Public Health England, Colindale, London, UK
| | - Mary E Ramsay
- Immunisation and Countermeasures Division, Public Health England, Colindale, London, UK
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Shen CF, Wang SM, Chi H, Huang YC, Huang LM, Huang YC, Lin HC, Ho YH, Hsiung CA, Liu CC. The potential role of pneumococcal conjugate vaccine in reducing acute respiratory inflammation in community-acquired pneumococcal pneumonia. J Biomed Sci 2020; 27:88. [PMID: 32814590 PMCID: PMC7435222 DOI: 10.1186/s12929-020-00680-9] [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] [Received: 08/07/2019] [Accepted: 08/07/2020] [Indexed: 11/23/2022] Open
Abstract
Background Pneumococcal conjugate vaccine (PCV) reduces both invasive pneumococcal disease (IPD) and other pneumococcal infections worldwide. We investigated the impact of stepwise implementation of childhood PCV programs on the prevalence of pneumococcal pneumonia, severity of acute inflammation, and associations between breakthrough pneumonia and pneumococcal serotypes in Taiwan. Methods In total, 983 children diagnosed with community-acquired pneumococcal pneumonia were enrolled between January 2010 and December 2015. Results Proportions of pneumococcal vaccinations increased each year in age-stratified groups with PCV7 (32.2%) as the majority, followed by PCV13 (12.2%). The proportion of pneumococcal pneumonia decreased each year in age-stratified groups, especially in 2–5 year group. Serotype 19A is the leading serotype either in vaccinated (6.4%) or unvaccinated patients (5.2%). In particular, vaccinated patients had significantly higher lowest WBC, lower neutrophils, lower lymphocytes and lower CRP values than non-vaccinated patients (p < 0.05). After stratifying patients by breakthrough infection, those with breakthrough pneumococcal infection with vaccine coverage serotypes had more severe pneumonia disease (p < 0.05). Conclusion Systematic childhood pneumococcal vaccination reduced the prevalence of community-acquired pneumococcal pneumonia, especially in 2–5 year group. Serotype 19A was the major serotype for all vaccine types in patients with pneumococcal pneumonia and severity of acute inflammatory response was reduced in vaccinated patients.
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Affiliation(s)
- Ching-Fen Shen
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138, Sheng Li Road, North Dist, Tainan, 70403, Taiwan.,Taiwan Pediatric Infectious Disease Alliance, Taipei City, Taiwan
| | - Shih-Min Wang
- Taiwan Pediatric Infectious Disease Alliance, Taipei City, Taiwan.,Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan City, Taiwan
| | - Hsin Chi
- Taiwan Pediatric Infectious Disease Alliance, Taipei City, Taiwan.,Department of Pediatrics, Mackay Children's Hospital, Mackay Medical College, Taipei City, Taiwan
| | - Yi-Chuan Huang
- Taiwan Pediatric Infectious Disease Alliance, Taipei City, Taiwan.,Division of Infectious Diseases, Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung City, Taiwan
| | - Li-Min Huang
- Taiwan Pediatric Infectious Disease Alliance, Taipei City, Taiwan.,Department of Pediatrics, National Taiwan University and Hospital, Taipei City, Taiwan
| | - Yhu-Chering Huang
- Taiwan Pediatric Infectious Disease Alliance, Taipei City, Taiwan.,Department of Pediatrics, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Hsiao-Chuan Lin
- Taiwan Pediatric Infectious Disease Alliance, Taipei City, Taiwan.,College of Medicine, China Medical University, Taichung City, Taiwan.,Division of Pediatric Infectious Diseases, China Medical University Children's Hospital, Taichung City, Taiwan
| | - Yu-Huai Ho
- Taiwan Pediatric Infectious Disease Alliance, Taipei City, Taiwan.,Division of Infectious Disease, Department of Medicine, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
| | - Chao A Hsiung
- Taiwan Pediatric Infectious Disease Alliance, Taipei City, Taiwan.,Institute of Population Health Sciences, National Health Research Institutes, Zhunan Township, Taiwan
| | - Ching-Chuan Liu
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138, Sheng Li Road, North Dist, Tainan, 70403, Taiwan. .,Taiwan Pediatric Infectious Disease Alliance, Taipei City, Taiwan. .,Center of Infectious Disease and Signaling Research, National Cheng Kung University, Tainan City, Taiwan.
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The clinical implication of serotype distribution and drug resistance of invasive pneumococcal disease in children: A single center study in southern Taiwan during 2010–2016. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2019; 52:937-946. [DOI: 10.1016/j.jmii.2019.04.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Revised: 04/01/2019] [Accepted: 04/30/2019] [Indexed: 12/23/2022]
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Carman KB, Calik M, Karal Y, Isikay S, Kocak O, Ozcelik A, Yazar AS, Nuhoglu C, Sag C, Kilic O, Dinleyici M, Lacinel Gurlevik S, Yimenicioglu S, Ekici A, Perk P, Tosun A, Isik I, Yarar C, Arslantas D, Dinleyici EC. Viral etiological causes of febrile seizures for respiratory pathogens (EFES Study). Hum Vaccin Immunother 2018; 15:496-502. [PMID: 30235060 PMCID: PMC6422444 DOI: 10.1080/21645515.2018.1526588] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 08/30/2018] [Accepted: 09/15/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Febrile seizure is the most common childhood neurological disorder, is an important health problem with potential short- and long-term complications, also leading to economic burden and increased parental anxiety about fevers and seizures occurring in their children. There are no routine recommendation to detect etiological causes of FS for neurological perspective, further knowledge about the etiological causes of FS in children will support preventive measures and follow-up strategies. The aim of this study is to evaluate the percentage of respiratory viruses in children with FS. METHODS This prospective multicenter study, entitled "Viral etiological causes of febrile seizures for respiratory pathogens (EFES Study)" examined representative populations in eight different cities in Turkey between March 1, 2016 and April 1, 2017. Nasopharyngeal swabs were taken from all children at presentation. A respiratory multiplex array was performed to detect for influenza A and B; respiratory syncytial virus A and B; human parainfluenza virus 1-2-3 and 4; human coronavirus 229E and OC43; human rhinovirus; human enterovirus; human adenovirus; human bocavirus; human metapneumovirus. RESULTS During the study period, at least one virus was detected in 82.7% (144/174) of children with FS. The most frequently detected virus was adenovirus, followed by influenza A and influenza B. Detection of more than one virus was present in 58.3% of the children with FS, and the most common co-existence was the presence of adenovirus and influenza B. In children younger than 12 months, Coronavirus OC43 was the most common, while influenza A was most frequently observed in children older than 48 months (p < 0.05). Human bocavirus was common in children who experienced complex FS, while respiratory syncytial virus (RSV) A was more common in children who experienced simple FS. Influenza B virus was the most common virus identified in children who were experiencing their first incidence of FS (p < 0.05). CONCLUSIONS This study indicates that respiratory viruses are important in the etiology of FS in children. The results show that antibiotics must be prescribed carefully in children with FS since the majority of cases are related to viral causes. Widespread use of the existing quadrivalent influenza vaccine might be useful for the prevention of FS related to the flu. Further vaccine candidates for potential respiratory pathogens, including RSV, might be helpful for the prevention of FS.
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Affiliation(s)
- Kursat Bora Carman
- Faculty of Medicine, Department of Pediatric Neurology, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Mustafa Calik
- Faculty of Medicine, Department of Pediatric Neurology, Harran University, Sanliurfa, Turkey
| | - Yasemin Karal
- Faculty of Medicine, Department of Pediatric Neurology, Trakya University, Edirne, Turkey
| | - Sedat Isikay
- Faculty of Medicine, Department of Pediatric Neurology, Hasan Kalyoncu University, Gaziantep, Turkey
| | - Ozan Kocak
- Department of Pediatric Neurology, Samsun Education and Research Hospital, Samsun, Turkey
| | - Aysima Ozcelik
- Faculty of Medicine, Department of Pediatric Neurology, Gaziantep University, Gaziantep, Turkey
| | - Ahmet Sami Yazar
- Department of Pediatrics, Umraniye Education and Research Hospital, Istanbul, Turkey
| | - Cagatay Nuhoglu
- Department of Pediatrics, Haydarapasa Numune Education and Research Hospital, Istanbul, Turkey
| | - Cigdem Sag
- Department of Pediatrics, Haydarapasa Numune Education and Research Hospital, Istanbul, Turkey
| | - Omer Kilic
- Faculty of Medicine, Pediatric Infectious Disease Unit, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Meltem Dinleyici
- Faculty of Medicine, Department of Social Pediatrics, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Sibel Lacinel Gurlevik
- Faculty of Medicine, Department of Pediatric Neurology, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Sevgi Yimenicioglu
- Department of Pediatric Neurology, Eskisehir Maternity and Children Hospital, Eskisehir, Turkey
| | - Arzu Ekici
- Department of Pediatric Neurology, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Peren Perk
- Faculty of Medicine, Department of Pediatric Neurology, Gaziantep University, Gaziantep, Turkey
| | - Ayse Tosun
- Faculty of Medicine, Department of Pediatric Neurology, Adnan Menderes University, Aydin, Turkey
| | - Ilhan Isik
- Department of Pediatric Neurology, Sanliurfa Children’s Hospital, Sanliurfa, Turkey
| | - Coskun Yarar
- Faculty of Medicine, Department of Pediatric Neurology, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Didem Arslantas
- Faculty of Medicine, Department of Public Health, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Ener Cagri Dinleyici
- Faculty of Medicine, Department of Pediatrics, Eskisehir Osmangazi University, Eskisehir, Turkey
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7
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Shen K, Wasserman M, Liu D, Yang YH, Yang J, Guzauskas GF, Wang BCM, Hilton B, Farkouh R. Estimating the cost-effectiveness of an infant 13-valent pneumococcal conjugate vaccine national immunization program in China. PLoS One 2018; 13:e0201245. [PMID: 30044865 PMCID: PMC6059448 DOI: 10.1371/journal.pone.0201245] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 07/11/2018] [Indexed: 01/29/2023] Open
Abstract
Background The burden of pneumococcal disease in China is high, and a 13-valent pneumococcal conjugate vaccine (PCV13) recently received regulatory approval and is available to Chinese infants. PCV13 protects against the most prevalent serotypes causing invasive pneumococcal disease (IPD) in China, but will not provide full societal benefits until made broadly available through a national immunization program (NIP). Objective To estimate clinical and economic benefits of introducing PCV13 into a NIP in China using local cost estimates and accounting for variability in vaccine uptake and indirect (herd protection) effects. Methods We developed a population model to estimate the effect of PCV13 introduction in China. Modeled health states included meningitis, bacteremia, pneumonia (PNE), acute otitis media, death and sequelae, and no disease. Direct healthcare costs and disease incidence data for IPD and PNE were derived from the China Health Insurance and Research Association database; all other parameters were derived from published literature. We estimated total disease cases and associated costs, quality-adjusted life years (QALYs), and deaths for three scenarios from a Chinese Payer Perspective: (1) direct effects only, (2) direct+indirect effects for IPD only, and (3) direct+indirect effects for IPD and inpatient PNE. Results Scenario (1) resulted in 370.3 thousand QALYs gained and 12.8 thousand deaths avoided versus no vaccination. In scenarios (2) and (3), the PCV13 NIP gained 383.2 thousand and 3,580 thousand QALYs, and avoided 13.1 thousand and 147.5 thousand deaths versus no vaccination, respectively. In all three scenarios, the vaccination cost was offset by cost reductions from prevented disease yielding net costs of ¥29,362.32 million, ¥29,334.29 million, and ¥13,524.72 million, respectively. All resulting incremental cost-effectiveness ratios fell below a 2x China GDP cost-effectiveness threshold across a range of potential vaccine prices. Discussion Initiation of a PCV13 NIP in China incurs large upfront costs but is good value for money, and is likely to prevent substantial cases of disease among children and non-vaccinated individuals.
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Affiliation(s)
- Kunling Shen
- Department of Respiratory Diseases, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | | | | | - Yong-Hong Yang
- Key Laboratory of Major Diseases in Children and National Key Discipline of Pediatrics (Capital Medical University), Ministry of Education, National Clinical Research Centre for Respiratory Diseases, Beijing Key Laboratory of Pediatric Respiratory Infection Diseases, Laboratory of Microbiology, Beijing Children's Hospital, Beijing Pediatric Research Institute, Capital Medical University, Beijing, China
| | | | | | | | - Betsy Hilton
- Pfizer Inc. Collegeville, PA, United States of America
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Wasserman M, Sings HL, Jones D, Pugh S, Moffatt M, Farkouh R. Review of vaccine effectiveness assumptions used in economic evaluations of infant pneumococcal conjugate vaccine. Expert Rev Vaccines 2017; 17:71-78. [DOI: 10.1080/14760584.2018.1409116] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Jallow S, Madhi SA. Pneumococcal conjugate vaccine in HIV-infected and HIV-exposed, uninfected children. Expert Rev Vaccines 2017; 16:453-465. [PMID: 28351187 DOI: 10.1080/14760584.2017.1307740] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Incidence of invasive pneumococcal disease (IPD) among HIV-infected children is 20-40 fold greater compared to HIV-uninfected children, including among HIV-infected children on antiretroviral therapy (ART). Also, HIV-exposed, uninfected children have 2.7-fold greater risk of IPD compared to HIV-unexposed children. Areas covered: We reviewed studies identified on Pubmed database with the terms 'PCV' and 'HIV'; studies involving adults only were excluded. Expert commentary: While ART and pneumococcal conjugate vaccines (PCV) have reduced IPD morbidity and mortality in HIV-infected children, ART-naïve and immunosuppressed children have inferior immunogenicity to most PCV serotypes; highlighting the need for concomitant use of ART with PCV. Furthermore, studies to determine optimal PCV dosing schedules, timing and number of doses, are urgently required to ensure sustained vaccine efficacy in HIV-infected children.
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Affiliation(s)
- Sabelle Jallow
- a Respiratory and Meningeal Pathogens Unit, Faculty of Health Sciences , University of Witwatersrand , Johannesburg , South Africa.,b Centre for Vaccines and Immunology , National Institute for Communicable Diseases of the National Health Laboratory Service , Johannesburg , South Africa
| | - Shabir A Madhi
- a Respiratory and Meningeal Pathogens Unit, Faculty of Health Sciences , University of Witwatersrand , Johannesburg , South Africa.,b Centre for Vaccines and Immunology , National Institute for Communicable Diseases of the National Health Laboratory Service , Johannesburg , South Africa
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Effectiveness of Pneumococcal Conjugate Vaccines of Different Valences Against Invasive Pneumococcal Disease Among Children in Taiwan: A Nationwide Study. Pediatr Infect Dis J 2016; 35:e124-33. [PMID: 26974752 DOI: 10.1097/inf.0000000000001054] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND For the scarcity of data, we investigated the vaccine effectiveness (VE) of the combined use of pneumococcal conjugate vaccines (PCVs) of different valences against invasive pneumococcal disease (IPD) in children. METHODS We conducted a matched case-control study using the national IPD surveillance database and the national vaccination registry. Four age-matched, gender-matched and neighborhood-matched controls were identified for each incident IPD case ≦5 years with disease onsets between October 2007 and December 2013. Conditional logistic regression was used to assess VE against all serotype and serotype 19A IPD. RESULTS In 523 cases (median age: 28.5 months; range: 2.0-69.4 months) and 2086 controls (28.7; 2.2-70.1), a similar VE against all-serotype IPD was found between PCV13 (76%; 61-85%) and combined 7-valent PCV (PCV7)/10-valent PCV (PCV10) plus PCV13 (78%; 56-89%). The VE for PCV7/PCV10 was slightly lower (48%; 32-60%). Regarding serotype 19A, a significantly reduced risk was observed for both PCV13 (82%; 63-91%) and combined PCV7/PCV10 plus PCV13 (87%; 61-96%). PCV7/PCV10 had only a borderline protective association (31%; 4-51%). For children receiving PCV13 alone, VE against all-serotype IPD did not differ between starting the dosing at ≥2 (78%; 56-89%) or <2 (74%; 51-87%) years of age. VE was 81% (69-88%) within 6 months of the last dose of PCV and 19% (95% CI: -21 to 45%) after 2 years. CONCLUSIONS PCVs are effective against IPD during immunization with either the same or with a mixed series, but protection might be differential over time.
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del Amo E, Esteva C, Hernandez-Bou S, Galles C, Navarro M, Sauca G, Diaz A, Gassiot P, Marti C, Larrosa N, Ciruela P, Jane M, Sá-Leão R, Muñoz-Almagro C. Serotypes and Clonal Diversity of Streptococcus pneumoniae Causing Invasive Disease in the Era of PCV13 in Catalonia, Spain. PLoS One 2016; 11:e0151125. [PMID: 26953887 PMCID: PMC4783110 DOI: 10.1371/journal.pone.0151125] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 02/24/2016] [Indexed: 11/28/2022] Open
Abstract
The aim of this study was to study the serotypes and clonal diversity of pneumococci causing invasive pneumococcal disease in Catalonia, Spain, in the era of 13-valent pneumococcal conjugate vaccine (PCV13). In our region, this vaccine is only available in the private market and it is estimated a PCV13 vaccine coverage around 55% in children. A total of 1551 pneumococcal invasive isolates received between 2010 and 2013 in the Molecular Microbiology Department at Hospital Sant Joan de Déu, Barcelona, were included. Fifty-two serotypes and 249 clonal types-defined by MLST-were identified. The most common serotypes were serotype 1 (n = 182; 11.7%), 3 (n = 145; 9.3%), 19A (n = 137; 8.8%) and 7F (n = 122; 7.9%). Serotype 14 was the third most frequent serotype in children < 2 years (15 of 159 isolates). PCV7 serotypes maintained their proportion along the period of study, 16.6% in 2010 to 13.4% in 2013, whereas there was a significant proportional decrease in PCV13 serotypes, 65.3% in 2010 to 48.9% in 2013 (p<0.01). This decrease was mainly attributable to serotypes 19A and 7F. Serotype 12F achieved the third position in 2013 (n = 22, 6.4%). The most frequent clonal types found were ST306 (n = 154, 9.9%), ST191 (n = 111, 7.2%), ST989 (n = 85, 5.5%) and ST180 (n = 80, 5.2%). Despite their decrease, PCV13 serotypes continue to be a major cause of disease in Spain. These results emphasize the need for complete PCV13 vaccination.
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Affiliation(s)
- Eva del Amo
- Department of Molecular Microbiology, Hospital Sant Joan de Deu, Esplugues de Llobregat, Spain
| | - Cristina Esteva
- Department of Molecular Microbiology, Hospital Sant Joan de Deu, Esplugues de Llobregat, Spain
| | - Susanna Hernandez-Bou
- Department of Paediatrics, Hospital Sant Joan de Deu and University of Barcelona, Esplugues de Llobregat, Spain
| | - Carmen Galles
- Department of Microbiology, Hospital Sant Jaume, Calella, Spain
| | | | - Goretti Sauca
- Department of Microbiology, Hospital de Mataró, Mataró, Spain
| | - Alvaro Diaz
- Department of Microbiology, Hospital de Nens, Barcelona, Spain
| | - Paula Gassiot
- Department of Microbiology, Hospital de Figueres, Figueres, Spain
| | - Carmina Marti
- Department of Microbiology, Hospital General de Granollers, Granollers, Spain
| | - Nieves Larrosa
- Department of Microbiology, Hospital Vall d’Hebron, Barcelona, Spain
| | - Pilar Ciruela
- Public Health Agency, Government of Catalonia, Barcelona, Spain
| | - Mireia Jane
- Public Health Agency, Government of Catalonia, Barcelona, Spain
| | - Raquel Sá-Leão
- Laboratory of Molecular Microbiology of Human Pathogens, Instituto de Tecnologia Química e Biológica, Universidade Nova de Lisboa, Oeiras, Portugal
| | - Carmen Muñoz-Almagro
- Department of Molecular Microbiology, Hospital Sant Joan de Deu, Esplugues de Llobregat, Spain
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Shiragami M, Mizukami A, Leeuwenkamp O, Mrkvan T, Delgleize E, Kurono Y, Iwata S. Cost-Effectiveness Evaluation of the 10-Valent Pneumococcal Non-typeable Haemophilus influenzae Protein D Conjugate Vaccine and 13-Valent Pneumococcal Vaccine in Japanese Children. Infect Dis Ther 2014; 4:93-112. [PMID: 25527448 PMCID: PMC4363214 DOI: 10.1007/s40121-014-0053-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Indexed: 10/29/2022] Open
Abstract
INTRODUCTION Diseases caused by Streptococcus pneumoniae represent a major public health problem. The purpose of this study was to compare, in the Japanese context, the projected health benefits, costs and cost-effectiveness of the latest generation of pneumococcal conjugate vaccines which may provide important insight into the potential public health impact of interventions in the context of local disease-specific epidemiology. METHODS A Markov model was used to compare two vaccination strategies which involve routine infant immunization with either the 13-valent pneumococcal conjugate vaccine (PCV-13; Prevenar 13™, Pfizer, Pearl River, NY, USA) or the 10-valent pneumococcal non-typeable Haemophilus influenzae protein D conjugate vaccine (PHiD-CV; Synflorix™, GlaxoSmithKline Biologicals SA, Rixensart, Belgium) over a time horizon of 5 years from the healthcare provider and societal perspectives. Estimates for key model parameters were obtained from locally available databases and published literature. Incremental benefits in terms of costs and quality-adjusted life-year and cost-effectiveness were assessed. RESULTS A 3 + 1 vaccination schedule for infants with PHiD-CV is expected to have a similar impact on invasive pneumococcal disease and pneumonia and a larger impact on acute otitis media-related outcomes compared with PCV-13. Assuming price parity for these vaccines, the model projected that vaccination with PHiD-CV would result in cost savings of 1.9 and 3.9 billion Japanese yen from the provider and societal perspectives, respectively. This was largely due to a reduction in highly prevalent acute otitis media. Vaccination with PHiD-CV was expected to generate a gain of 433 quality-adjusted life-years compared to PCV-13 translating into dominance over PCV-13. Sensitivity analyses showed robustness of model outcome to changes in key model parameters and substantiated that the model outcome was consistently driven by the incremental benefit of PHiD-CV in averting acute otitis media. CONCLUSION In comparison to PCV-13, vaccination with PHiD-CV is projected to be cost saving for Japan from both the healthcare provider and societal perspectives.
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Affiliation(s)
- Makoto Shiragami
- Social and Administrative Pharmacy Science, School of Pharmacy, Nihon University, Funabashi-shi, Chiba Japan
| | - Akiko Mizukami
- Healthoutcomes Department, Development and Medical Affairs Division, GlaxoSmithKline K.K., Shibuya-ku, Tokyo, Japan
| | | | - Tomas Mrkvan
- Vaccine Value and Health Science, GSK Vaccines, Wavre, Belgium
| | | | - Yuichi Kurono
- Department of Otolaryngology, Faculty of Medicine, Kagoshima University, Kagoshima-shi, Kagoshima Japan
| | - Satoshi Iwata
- Department of Infectious Diseases, Keio University School of Medicine, Shinjuku-ku, Tokyo Japan
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Abstract
Necrotising pneumonia remains an uncommon complication of pneumonia in children but its incidence is increasing. Pneumococcal infection is the predominant cause in children but Methicillin resistant Staphylococcus aureus (MRSA) and Panton-Valentine leukocidin (PVL) staphylococcal infection are also important causes of severe necrotising pneumonia. Clinical features of necrotic pneumonia are similar to those of an uncomplicated pneumonia except that the patient is clinically much more unwell and has usually failed to respond adequately to what would normally be considered as appropriate antibiotics. Pleural involvement is frequent. Initial management is similar to that for non-complicated pneumonia with careful attention to fluid balance and adequate analgesia required. Some patients will need intensive care support, particularly those with PVL-positive staphylococcal infection. Broad-spectrum antibiotics should be given intravenously, with the exact choice of agent informed by local resistance patterns. Pleural drainage is often required. Despite the severity of the illness, outcomes remain excellent with the majority of children making a full recovery.
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Dinleyici EC. Current status of pneumococcal vaccines: lessons to be learned and new insights. Expert Rev Vaccines 2014; 9:1017-22. [PMID: 20822344 DOI: 10.1586/erv.10.86] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Ener Cagri Dinleyici
- Eskisehir Osmangazi University Faculty of Medicine, Department of Pediatrics, Eskisehir, TR-26480 Turkey.
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Dinleyici EC, Yuksel F, Yargic ZA, Unalacak M, Unluoglu I. Results of a national study on the awareness of and attitudes toward acute otitis media (AOM) among clinicians and the estimated direct healthcare costs in Turkey (TR-AOM Study). Int J Pediatr Otorhinolaryngol 2013; 77:756-61. [PMID: 23433920 DOI: 10.1016/j.ijporl.2013.02.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2012] [Revised: 01/31/2013] [Accepted: 02/03/2013] [Indexed: 11/25/2022]
Abstract
AIMS Acute otitis media (AOM) is one of the most frequent diagnoses and reasons for prescribing antibiotics in children. The aims of this prospective study were the following: (1) to assess the continuing education of physicians and the sources of information about AOM; (2) to assess the current knowledge of and attitudes toward AOM as well as the compliance with AOM guidelines; (3) to evaluate opinions about vaccines against AOM; and (4) to estimate the potential costs of AOM on the healthcare system in Turkey. METHODS This is a web-based cross-sectional survey of a national convenience sample of 600 physicians in Turkey (325 pediatricians (PEDs), 214 family physicians/general practitioners (FP&GPs) and 61 otolaryngologists (ENTs)). RESULTS Approximately 38.6% of participants (39.4% of PEDs, 44.3% of GP&FPs and 14.7% of ENTs) stated that pneumatic otoscopy is essential for AOM diagnosis. Regarding the most common etiological agents of AOM in children, 54.2% of PEDs, 51.4% of FP&GPs and 57.4% of ENTs stated that the most common causative agents of AOM are Streptococcus pneumoniae and non-typeable Haemophilus influenzae. Nearly 76% of participants indicated they use direct antibiotic therapy when they diagnose AOM in certain situations. The first-line choice of antibiotic therapy is amoxicillin clavulanate, and 67% of participants prefer to use antibiotic therapy for 7-10 days. Approximately 31% of all participants stated that "viruses" are the main cause of AOM; however, 62% of these participants reported using antibiotic therapy. In comparison, 32% participants from private clinics prefer to treat AOM primarily with observation, a rate that is significantly higher than that of other clinical settings. Physicians who prefer to use observation strategy also prefer the combination of paracetamol and NSAIDs. Approximately 41% of participants have undergone postgraduate medical education on the topic of AOM. In total, 73% of all participant physicians believe that otitis media is a vaccine-preventable disease. With the information from all of the participants, the calculated mean cost per case of AOM is 28 ± 4 USD. In Turkey, the estimated incidence of AOM is 24,000-33,000 cases per 10,000 children <5 years of age (1,820,000-2,100,000 cases per year), and the estimated total cost of AOM is 61,152,000 USD (not including acute otitis media-related complications and otitis media-related hospitalizations). CONCLUSION The medical and economic burden of AOM to the health economics in Turkey is considerable. Specific educational programs and evidence-based national guidelines concerning AOM should be implemented. Improving diagnostic accuracy with education will lead to improved management, judicious use of antibiotics, decreased antibiotic resistance, and potential economic benefits. A more prudent use of antibiotics would also lower the economic burden of this disease. Vaccination seems to be promising for the prevention of AOM.
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Affiliation(s)
- Ener Cagri Dinleyici
- Eskisehir Osmangazi University Faculty of Medicine, Department of Pediatrics, Eskisehir, Turkey.
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16
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Nanogel-based PspA intranasal vaccine prevents invasive disease and nasal colonization by Streptococcus pneumoniae. Infect Immun 2013; 81:1625-34. [PMID: 23460513 DOI: 10.1128/iai.00240-13] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
To establish a safer and more effective vaccine against pneumococcal respiratory infections, current knowledge regarding the antigens common among pneumococcal strains and improvements to the system for delivering these antigens across the mucosal barrier must be integrated. We developed a pneumococcal vaccine that combines the advantages of pneumococcal surface protein A (PspA) with a nontoxic intranasal vaccine delivery system based on a nanometer-sized hydrogel (nanogel) consisting of a cationic cholesteryl group-bearing pullulan (cCHP). The efficacy of the nanogel-based PspA nasal vaccine (cCHP-PspA) was tested in murine pneumococcal airway infection models. Intranasal vaccination with cCHP-PspA provided protective immunity against lethal challenge with Streptococcus pneumoniae Xen10, reduced colonization and invasion by bacteria in the upper and lower respiratory tracts, and induced systemic and nasal mucosal Th17 responses, high levels of PspA-specific serum immunoglobulin G (IgG), and nasal and bronchial IgA antibody responses. Moreover, there was no sign of PspA delivery by nanogel to either the olfactory bulbs or the central nervous system after intranasal administration. These results demonstrate the effectiveness and safety of the nanogel-based PspA nasal vaccine system as a universal mucosal vaccine against pneumococcal respiratory infection.
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Principi N, Baggi E, Esposito S. Prevention of acute otitis media using currently available vaccines. Future Microbiol 2012; 7:457-65. [DOI: 10.2217/fmb.12.23] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Acute otitis media (AOM) is common in infants and children. Although approximately two-thirds of cases are due to bacteria, almost all of the episodes are preceded by upper respiratory viral infection. Several viruses, among which respiratory syncytial virus is the most common, are involved in the determination of AOM. However, a significant number of AOM cases are associated with influenza infection, and influenza viruses are among the most frequently found respiratory viruses in the middle ear fluid during an acute episode of AOM. Consequently, influenza vaccination may have a favorable impact on the incidence and course of AOM. Moreover, as Streptococcus pneumoniae is one of the leading AOM bacterial pathogens and it is well known that influenza virus infection predisposes to pneumococcal infection, there is a further reason to suggest the use of influenza vaccine to reduce the risk of AOM. On the other hand, the administration of pneumococcal conjugate vaccine is considered per se a possible means of reducing the incidence of the disease. However, although a number of studies have measured the impact of both vaccines on AOM, it is still not known whether (and to what extent) they are really effective, nor what impact the more recently licensed vaccines may have. The aim of this review is to examine the clinical impact of vaccinations on AOM.
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Affiliation(s)
- Nicola Principi
- Department of Maternal & Pediatric Sciences, Università degli Studi di Milano, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Commenda 9, 20122 Milano, Italy
| | - Elena Baggi
- Department of Maternal & Pediatric Sciences, Università degli Studi di Milano, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Commenda 9, 20122 Milano, Italy
| | - Susanna Esposito
- Department of Maternal & Pediatric Sciences, Università degli Studi di Milano, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Commenda 9, 20122 Milano, Italy
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Principi N, Esposito S. Use of the 13-valent pneumococcal conjugate vaccine in infants and young children. Expert Opin Biol Ther 2012; 12:641-8. [PMID: 22397739 DOI: 10.1517/14712598.2012.670217] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION The inclusion of the heptavalent pneumococcal conjugate vaccine (PCV7) in the immunization schedule of infants and young children has greatly reduced the incidence of invasive and non-invasive diseases due to Streptococcus pneumoniae. However, as PCV7 has some limitations, new vaccines containing more pneumococcal serotypes have been developed. Only two of these have so far reached the market: a 10-valent preparation containing the PCV7 serotypes plus serotypes 1, 5 and 7F (PCV10), and a 13-valent vaccine containing the PCV7 serotypes plus serotypes 1, 3, 5, 6A, 7F and 19A (PCV13). AREAS COVERED The main aim of this review is to discuss the reasons that have led to the formulation of PCV13, its immunogenicity, safety and tolerability and the recommendations concerning its use in children. EXPERT OPINION There is no doubt that a pneumococcal conjugate vaccine with the composition of PCV13 has significantly increased the possibility of preventing pneumococcal disease. Its immunogenicity, safety and tolerability seem to be optimal, as does its cost-effectiveness. However, despite these favorable premises, it cannot be considered the final preparation for the prevention of pneumococcal disease, and it is likely that a new vaccine capable of covering all pneumococcal serotypes will be needed in the future.
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Affiliation(s)
- Nicola Principi
- Department of Maternal and Pediatric Sciences, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy.
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Chen Y, Deng W, Wang SM, Mo QM, Jia H, Wang Q, Li SG, Li X, Yao BD, Liu CJ, Zhan YQ, Ji C, Lopez AL, Wang XY. Burden of pneumonia and meningitis caused by Streptococcus pneumoniae in China among children under 5 years of age: a systematic literature review. PLoS One 2011; 6:e27333. [PMID: 22110628 PMCID: PMC3217934 DOI: 10.1371/journal.pone.0027333] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2011] [Accepted: 10/14/2011] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND METHODS To understand the burden and epidemiology of Streptococcus pneumoniae disease among children between 1 and 59 months of age in China, we conducted a review of literature published between 1980 and 2008 applying standardized algorithms. Because of the absence of population-based surveillance for pneumococcal disease (PD), we identified all-cause pneumonia, bacteremia and meningitis burden, syndromes most commonly associated with S. pneumoniae, and applied the proportion of disease attributable to S. pneumoniae from studies that determined the etiology of these three syndromes to calculate PD burden. Because of the microbiologic difficulties in identifying S. pneumoniae-attributable pneumonia which likely underestimates the pneumonia burden, we also used the proportion obtained from vaccine efficacy trials. RESULTS Between 1980 and 2008, there were 12,815 cases/100,000/year of all-cause pneumonia among children between 1 month and 59 months, with 526 deaths/100,000 annually. There were 14 meningitis cases/100,000/year. We estimate that as of 2000, there were 260,768 (113,000 to 582,382) and 902 (114-4,463) cases of pneumococcal pneumonia and meningitis, respectively with 10,703 (4,638-23,904) and 75 (9-370) pneumococcal pneumonia and meningitis deaths, respectively. Pneumococcal pneumonia cases and deaths were more than two-fold higher, 695,382 (173,845-1,216,918) and 28,542 (7,136-49,949), respectively, when parameters from efficacy trials were used. Serotypes 19F, 19A and 14 were the most common serotypes obtained from pneumonia/meningitis patients. Currently available vaccines are expected to cover 79.5% to 88.4% of the prevalent serotypes. With high antibiotic resistance, introducing pneumococcal vaccines to the routine immunization program should be considered in China. Population-based studies are warranted.
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Affiliation(s)
- Ying Chen
- Institutes of Biomedical Sciences, Fudan University, Shanghai, People's Republic of China
| | - Wei Deng
- Department of Health Statistics and Social Medicine, School of Public Health, Fudan University, Shanghai, People's Republic of China
| | - Song-Mei Wang
- Laboratory of Medical Molecular Biology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
| | - Qi-Mei Mo
- Institutes of Biomedical Sciences, Fudan University, Shanghai, People's Republic of China
| | - Huan Jia
- Department of Health Statistics and Social Medicine, School of Public Health, Fudan University, Shanghai, People's Republic of China
| | - Qun Wang
- Department of Health Statistics and Social Medicine, School of Public Health, Fudan University, Shanghai, People's Republic of China
| | - Song-Guang Li
- Department of Health Statistics and Social Medicine, School of Public Health, Fudan University, Shanghai, People's Republic of China
| | - Xiang Li
- Department of Health Statistics and Social Medicine, School of Public Health, Fudan University, Shanghai, People's Republic of China
| | - Bao-Dong Yao
- Department of Health Statistics and Social Medicine, School of Public Health, Fudan University, Shanghai, People's Republic of China
| | - Cheng-Jun Liu
- Department of Health Statistics and Social Medicine, School of Public Health, Fudan University, Shanghai, People's Republic of China
| | - Yi-Qiang Zhan
- Department of Health Statistics and Social Medicine, School of Public Health, Fudan University, Shanghai, People's Republic of China
| | - Chen Ji
- Pfizer Inc., New York, New York, United States of America
| | | | - Xuan-Yi Wang
- Institutes of Biomedical Sciences, Fudan University, Shanghai, People's Republic of China
- Key Laboratory of Medical Molecular Virology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
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Zangeneh TT, Baracco G, Al-Tawfiq JA. Impact of conjugate pneumococcal vaccines on the changing epidemiology of pneumococcal infections. Expert Rev Vaccines 2011; 10:345-53. [PMID: 21434802 DOI: 10.1586/erv.11.1] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Streptococcus pneumoniae-related infections have a major global impact on healthcare, especially in the developing world, and are considered the number one vaccine-preventable cause of death in children. There are more than 90 pneumococcal serotypes and 46 serogroups. The first capsular polysaccharide pneumococcal vaccine was licensed in the USA in 1977 for individuals older than 2 years of age at high risk for pneumococcal disease. Two decades later, the first 7-valent pneumococcal polysaccharide-protein conjugate vaccine completed the required clinical trials and was introduced as part of the national immunization program of various countries. New-generation vaccines that include emerging serotypes, while maintaining protection against the 7-valent pneumococcal serotypes, have recently been approved. With the addition of these serotypes, the majority of potential pneumococcal serotypes causing invasive disease in most parts of the world could be covered.
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Affiliation(s)
- Tirdad T Zangeneh
- Division of Infectious Diseases, University of Miami Miller School of Medicine and the Miami Veterans Affairs Healthcare System, Miami, FL, USA
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21
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Paradiso PR. Advances in Pneumococcal Disease Prevention: 13-Valent Pneumococcal Conjugate Vaccine for Infants and Children. Clin Infect Dis 2011; 52:1241-7. [DOI: 10.1093/cid/cir142] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
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Metersky ML, Dransfield MT, Jackson LA. Determining the optimal pneumococcal vaccination strategy for adults: is there a role for the pneumococcal conjugate vaccine? Chest 2010; 138:486-90. [PMID: 20576729 DOI: 10.1378/chest.10-0738] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
On February 24, 2010, the US Food and Drug Administration approved a 13-valent pneumococcal protein conjugate vaccine (PCV13) for use in children. Currently, the only pneumococcal vaccine approved for use in adults in the United States is the 23-valent pneumococcal polysaccharide vaccine (PPV23). Although PPV23 provides partial protection against invasive pneumococcal disease, it does not appear to impact the risk of pneumonia in elderly patients or younger adults with comorbidities. Experience with PCV7 in children and studies of the immunogenicity of PCV7 in high-risk adults suggest that PCV13 may be effective in adults. However, prior receipt of PPV23 may blunt the antibody response to protein conjugate vaccination; thus, receipt of PPV23 could potentially diminish the benefit of subsequent pneumococcal conjugate vaccination. The approval of PCV13 for children has created a unique dilemma for physicians seeking to provide optimum protection for their high-risk adult patients. Potential options could include use of the PCV13 "off-label," perhaps followed by PPV23; withholding pneumococcal vaccination of adults while awaiting approval of PCV13; or continuing to use the PPV23. Although there are limited data on PCVs in adults, the availability of PCV13 for children will likely cause uncertainty for some physicians until there is updated official guidance regarding the optimum strategies for prevention of pneumococcal infection in adults.
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Affiliation(s)
- Mark L Metersky
- Center for Bronchiectasis Care, Division of Pulmonary and Critical Care Medicine, University of Connecticut School of Medicine, Farmington, CT 06030-1321, USA.
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Reinert RR, Paradiso P, Fritzell B. Advances in pneumococcal vaccines: the 13-valent pneumococcal conjugate vaccine received market authorization in Europe. Expert Rev Vaccines 2010; 9:229-36. [PMID: 20218848 DOI: 10.1586/erv.10.6] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Hoa NQ, Trung NV, Larsson M, Eriksson B, Phuc HD, Chuc NT, Lundborg CS. Decreased Streptococcus pneumoniae susceptibility to oral antibiotics among children in rural Vietnam: a community study. BMC Infect Dis 2010; 10:85. [PMID: 20356399 PMCID: PMC2853544 DOI: 10.1186/1471-2334-10-85] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2009] [Accepted: 03/31/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Streptococcus pneumoniae is the most significant bacterial cause of community-acquired pneumonia among children under five years worldwide. Updated resistance information of S. pneumoniae among children is essential to adjust the recommendations for empirical treatment of community-acquired pneumonia, which will have immense implications for local and global health. This study investigated the prevalence of antibiotic resistance in isolated strains of S. pneumoniae and relationship with antibiotic use and demographic factors of children under five in rural Vietnam in 2007. METHODS In Bavi district, 847 children 6 to 60 months were selected from 847 households. The main child-caregivers in the households were interviewed weekly using structured questionnaires to collect information of daily illness symptoms and drug use for the selected child over a four-week period (from March through June 2007). In the 3rd week, the children were invited for a clinical examination and to collect nasopharyngeal samples for S. pneumoniae identification. Etest and disk diffusion were used to test antibiotic susceptibility. RESULTS Of 818 participating children, 258 (32%) had ongoing respiratory infections, 421 (52%) carried S. pneumoniae, and 477 (58%) had used antibiotics within the previous three weeks. Of the 421 isolates, 95% were resistant to at least one antibiotic (401/421). Resistance to co-trimoxazole, tetracycline, phenoxymethylpenicillin, erythromycin and ciprofloxacin was 78%, 75%, 75%, 70% and 28%, respectively. Low resistance was noted for amoxicillin (4%), benzylpenicillin (4%), and cefotaxime (2%). The intermediate resistance to amoxicillin was 32%. Multidrug-resistance was seen in 60%. The most common pattern was co-resistance to co-trimoxazole, tetracycline and erythromycin. The proportion of children carrying resistant bacteria was higher among the children who had used antibiotics in the previous three weeks. CONCLUSIONS Resistance to commonly used antibiotics and multidrug-resistance of S. pneumoniae in the area is remarkably high. High-dose amoxicillin is the only investigated oral antibiotic that can possibly be used for treatment of community-acquired pneumococcal infections. Strategies to promote appropriate prescribing and dispensing of effective antibiotics should be immediately implemented for the benefit of local and global health.
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Affiliation(s)
- Nguyen Quynh Hoa
- Division of Global Health (IHCAR), Department of Public Health Sciences, Karolinska Institutet, Nobels väg 9, 171 77 Stockholm, Sweden.
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Dinleyici EC, Kurugol Z. 6th World Congress of the World Society for Pediatric Infectious Diseases (WSPID). Expert Rev Vaccines 2010; 9:261-72. [PMID: 20218854 DOI: 10.1586/erv.10.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The 6th World Congress of the World Society for Pediatric Infectious Diseases (WSPID) was held in Buenos Aires, Argentina between 18 and 22 November, 2009. This is one of the biggest pediatric infectious disease assemblies in the world and it brought together pediatricians and pediatric infectious disease and vaccine experts. Numerous topics about pediatric infectious diseases were discussed during the congress. The scientific program focused on vaccines and vaccine-preventable diseases, including epidemiological and vaccine efficacy trials and updates on topics of childhood infectious disease. We summarize the current knowledge about some childhood vaccines and vaccine-preventable diseases, including rotavirus vaccines, conjugated pneumococcal vaccines (PCV-7, PHiD-CV and PCV-13), varicella, pertussis meningococcal and pandemic H1N1 vaccines. The next WSPID congress will be held in Melbourne, Australia between 16 and 20 November 2011.
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Affiliation(s)
- Ener Cagri Dinleyici
- Eskisehir Osmangazi University Faculty of Medicine, Department of Pediatrics, TR-26480 Eskisehir, Turkey.
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26
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Ivády B. Pneumococcal conjugate vaccines in the prevention of childhood pneumonia. Acta Microbiol Immunol Hung 2010; 57:1-13. [PMID: 20350875 DOI: 10.1556/amicr.57.2010.1.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Lower respiratory tract infections are among the most important causes of childhood mortality worldwide, more than 2 million children die due to pneumonia every year. A number of infections caused by the main pathogens related to pneumonia can be prevented through vaccination ( S. pneumoniae, H. influenzae type-b, morbilli, pertussis, influenza). In the last decade, after the introduction of the 7-valent pneumococcal conjugated vaccine (PCV), the epidemiological background of childhood pneumonia has changed. Recently, several studies have been performed to collect data and evidences about the efficacy of PCV against noninvasive pneumococcal diseases (e.g. pneumonia, otitis media). These investigations showed 10-50% decrease of all pneumonia cases, 10-30% decrease of radiologically diagnosed pneumonia, and 50-70% decrease of the incidence of pneumococcal pneumonia in children. The aim of this review was to determine the role of the PCV in the prevention of childhood pneumonia according to the medical literature, and to summarize the efforts of global organizations (WHO, UNICEF, GAVI) in the fight against pneumonia in children.
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Smeesters PR, McMillan DJ, Sriprakash KS, Georgousakis MM. Differences among group A streptococcus epidemiological landscapes: consequences for M protein-based vaccines? Expert Rev Vaccines 2010; 8:1705-20. [PMID: 19905872 DOI: 10.1586/erv.09.133] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Group A streptococcus (GAS) is a bacterial pathogen responsible for a wide array of disease pathologies in humans. GAS surface M protein plays multiple key roles in pathogenesis, and serves as a target for typing and vaccine development. In this review, we have compiled GAS epidemiological studies from several countries around the world to highlight the consequences on the theoretical efficacy of two different M protein-based vaccine strategies.
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Affiliation(s)
- Pierre R Smeesters
- Bacterial Pathogenesis Laboratory, Queensland Institute of Medical Research, Brisbane, Queensland 4029, Australia.
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Nasopharyngeal carriage of Streptococcus pneumoniae in Gambian children who participated in a 9-valent pneumococcal conjugate vaccine trial and in their younger siblings. Pediatr Infect Dis J 2009; 28:990-5. [PMID: 19536041 DOI: 10.1097/inf.0b013e3181a78185] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Nasopharyngeal carriage of Streptococcus pneumoniae is extremely prevalent in The Gambia. We studied the effects of vaccination with pneumococcal conjugate vaccines on the carriage of individual serotypes and on antimicrobial resistance in vaccinated children and their younger siblings. METHODS A longitudinal study of a subsample of children (n=2342) who participated in a randomized, placebo controlled trial of a 9-valent pneumococcal conjugate vaccines (PCV-9) in The Gambia, and a cross-sectional study of non-PCV-9-vaccinated younger siblings (n=675). RESULTS Recipients of PCV-9 were less likely to carry vaccine serotypes 4, 6B, 9V, 14, 19F, and 23F but more likely to carry vaccine-associated 19A and 9 nonvaccine serotypes at approximately 6 months postvaccination (age, 12 months) than were controls (each P<0.05). At approximately 16 months postvaccination, carriage of vaccine-associated-serotype 6A was also significantly reduced (P<0.01) while 3 other nonvaccine serotypes were more prevalent in the PCV-9 recipients (each P<0.05). At 16 months, but not 6 months, postvaccination PCV-9 recipients had lower rate of carrying isolates resistant to tetracycline and trimethoprim-sulfamethoxazole (TMP-SMZ) than controls (risk ratio: 0.90 and 0.95, respectively; each P<0.05). There was no difference in patterns of carriage of pneumococci in younger siblings of PCV-9 or placebo recipients. CONCLUSIONS The effects of 9-valent pneumococcal conjugate vaccines on carriage of pneumococci persisted for at least 16 months postvaccination in Gambian children. Vaccination had no indirect effect on carriage in younger siblings and there was limited impact on antibiotic resistance.
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Dinleyici EC, Yargic ZA. Pneumococcal conjugated vaccine: PHiD-CV. Expert Rev Anti Infect Ther 2009; 7:1063-1074. [DOI: 10.1586/eri.09.84] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Dinleyici EC, Yargic ZA. 27th Annual Meeting of the European Society for Pediatric Infectious Disease. Expert Rev Vaccines 2009; 8:1143-1149. [DOI: 10.1586/erv.09.75] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Dinleyici EC, Yargic ZA. Current knowledge regarding the investigational 13-valent pneumococcal conjugate vaccine. Expert Rev Vaccines 2009; 8:977-986. [DOI: 10.1586/erv.09.68] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Rückinger S, van der Linden M, Reinert RR, von Kries R, Burckhardt F, Siedler A. Reduction in the incidence of invasive pneumococcal disease after general vaccination with 7-valent pneumococcal conjugate vaccine in Germany. Vaccine 2009; 27:4136-41. [PMID: 19406190 DOI: 10.1016/j.vaccine.2009.04.057] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2009] [Revised: 04/07/2009] [Accepted: 04/21/2009] [Indexed: 10/20/2022]
Abstract
General vaccination with the 7-valent pneumococcal conjugate vaccine was recommended in Germany in July 2006 for all children <2 years. The proportion of reported invasive pneumococcal disease (IPD) caused by vaccine serotypes before vaccine introduction was considerably lower than in the US. We report data from nationwide surveillance of IPD in children with two reporting sources, pediatric hospitals and microbiological laboratories in Germany. Incidence rates with regard to age groups and pneumococcal serotypes are based on capture recapture estimates combining the two reporting sources. Between July 1, 1997 and June 30, 2003, 2680 cases (an average 447 yearly cases) of IPD were observed in children <16 years in Germany compared to 223 cases between July 1, 2007 and June 30, 2008. A significant reduction in overall incidence (4/100,000-3.2/100,000) was attributed to significant reductions in children younger than 2 years (20.0/100,000-11.0/100,000). While the incidence of all serotypes included in the vaccine was reduced in the age group <2 years, the incidence of non-vaccine serotypes remained stable. These data show a first success of the pneumococcal vaccination program in Germany. Further changes in incidence and serotype distribution of IPD are subject to future surveillance.
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Affiliation(s)
- Simon Rückinger
- Ludwig-Maximilians-University of Munich, Institute of Social Pediatrics and Adolescent Medicine, Division of Epidemiology, Heiglhofstr. 63, 81377 München, Germany.
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Soininen A, Nohynek H, Lucero M, Jousimies K, Ugpo J, Williams G, Käyhty H. IgG antibody concentrations after immunization with 11-valent mixed-carrier pneumococcal conjugate vaccine in efficacy trial against pneumonia among Filipino infants. Vaccine 2009; 27:2680-8. [DOI: 10.1016/j.vaccine.2009.02.059] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2008] [Revised: 01/12/2009] [Accepted: 02/18/2009] [Indexed: 11/26/2022]
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