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Alvarez CA, Hall RG, Lin S, Perkins AR, Mortensen EM. Compliance with recommended pneumococcal vaccination schedule in patients treated for rheumatoid arthritis: A retrospective cohort study in the Veterans Affairs population. Vaccine 2024; 42:489-495. [PMID: 38177030 DOI: 10.1016/j.vaccine.2023.12.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 12/21/2023] [Accepted: 12/22/2023] [Indexed: 01/06/2024]
Abstract
INTRODUCTION Invasive pneumococcal disease (IPD) is a leading cause of death. Rheumatoid arthritis (RA) patients are at risk of IPD due to immunosuppressant medications. Up until 2022, two pneumococcal vaccines, the 13-valent Pneumococcal conjugate vaccine (PCV13) and pneumococcal polysaccharide vaccine (PPSV23), were recommended. Despite the recommendation change to give a single 20-valent PCV vaccine (PCV20), some still require multiple vaccinations. There is a need to identify barriers to vaccine uptake. METHODS We conducted a retrospective cohort study to assess the on-time vaccination rates for PCV13 and PPSV23 in treated RA patients between 2010 and 2018 using national Veterans Affairs data. Patients > 18 years of age diagnosed with RA and newly initiated on RA treatment were included. Pneumococcal vaccine compliance was assessed by measuring on-time receipt of PCV13 and PPSV23 vaccinations. We identified factors using multivariate logistic regression and described the occurrence of these factors using descriptive statistics. RESULTS A total of 39,243 patients were included in the study. Most patients were white (75.8 %), male (85.4 %), on methotrexate therapy (41.4 %). The average age was 62.3 years. The proportion of patients considered vaccine compliant is 43.9 %. The primary independent risk factors for vaccine non-compliance were black/African American race (Odds Ratio [OR] 1.26, 95 % Confidence Interval [CI] 1.19-1.34) or missing/unknown race (OR 1.45, 95 % CI 1.31-1.61), missing/unknown ethnicity (OR 1.21, 1.02-1.43), never married (OR 1.10, 95 % CI 1.02-1.19) or widowed (OR 1.23, 95 % CI 1.12-1.34), diagnosed with congestive heart failure (OR 1.10, 95 % CI 1.00-1.22), or dementia (OR 1.48, 95 % CI 1.16-1.91). The proportion of patients who were non-compliant in patients who were vaccine naïve was 32.1 % and the non-compliance rate for non-naïve patients was 65.3 %. CONCLUSIONS Providers should identify barriers to pneumococcal vaccination in RA patients to improve compliance. Efforts to increase vaccination should be tailored to specific high-risk groups.
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Affiliation(s)
- Carlos A Alvarez
- Jerry H Hodge School of Pharmacy Texas Tech University Health Sciences Center, Dallas, TX, United States; Center of Excellence in Real World Evidence, Dallas, TX, United States; VA North Texas Health Sciences Center, Dallas, TX, United States.
| | - Ronald G Hall
- Jerry H Hodge School of Pharmacy Texas Tech University Health Sciences Center, Dallas, TX, United States; Center of Excellence in Real World Evidence, Dallas, TX, United States
| | - Suzy Lin
- Jerry H Hodge School of Pharmacy Texas Tech University Health Sciences Center, Dallas, TX, United States
| | - Aaron R Perkins
- Jerry H Hodge School of Pharmacy Texas Tech University Health Sciences Center, Dallas, TX, United States; Center of Excellence in Real World Evidence, Dallas, TX, United States; VA North Texas Health Sciences Center, Dallas, TX, United States
| | - Eric M Mortensen
- VA North Texas Health Sciences Center, Dallas, TX, United States; UCONN School of Medicine, Farmington, CT, United States
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Danso SE, Frimpong A, Seneadza NAH, Ofori MF. Knowledge, attitudes, and practices of caregivers on childhood immunization in Okaikoi sub-metro of Accra, Ghana. Front Public Health 2023; 11:1230492. [PMID: 37780451 PMCID: PMC10540614 DOI: 10.3389/fpubh.2023.1230492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 08/21/2023] [Indexed: 10/03/2023] Open
Abstract
Background Immunization remains one of the most cost-effective health interventions. However, there are still issues of vaccine hesitancy especially in caregivers who are required to protect their children from vaccine-preventable diseases. This thwarts the overall vaccine coverage in disease-endemic areas such as sub-Saharan Africa. Therefore, to determine the factors that promote vaccine hesitancy in caregivers, this study sought to assess the knowledge, attitude, and practices of caregivers on childhood immunization in Okaikoi, a sub-metro of Accra in Ghana. Methods A cross-sectional study on childhood immunization was conducted to determine the knowledge, attitudes, and practices of caregivers. A total of 120 caregivers with infants aged 12 months to 23 months were interviewed with a structured questionnaire containing open-ended and closed-ended queries. Results From the community, infants whose caregivers had adhered completely to immunization constituted 53.3% while the rest were partially immunized. The two main deterrents to complete immunization were time constraints (25.8%) and forgetfulness (17.5%). It was observed that vaccination uptake and maternal level of education, as well as vaccination adverse reaction, did not impact the completion of the EPI program by these caregivers. Unfortunately, it was noted that caregivers with higher education levels were unable to complete their vaccination schedules due to their busy work schedules. Nonetheless, the main deterrent to adhering to complete childhood immunization was poor maternal knowledge (58%). Conclusion The study revealed that, the caregivers in the community had poor knowledge on vaccination and its benefits, and therefore, with no strict adherence to vaccination schedules. This promoted the incomplete immunization of children in the community by their caregivers. Also, since the main source of information with regard to immunization in the sub-metro was through the antenatal and postnatal child welfare clinics and the media, we recommend that the health workers collaborate with media personnel to ensure that standardized information is disseminated.
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Affiliation(s)
- Samuel E. Danso
- Department of Community Health, University of Ghana Medical and Dental School, College of Health Science, Accra, Ghana
- GA East Hospital, Accra, Ghana
| | - Augustina Frimpong
- Department of Immunology, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Nana A. H. Seneadza
- Department of Community Health, University of Ghana Medical and Dental School, College of Health Science, Accra, Ghana
| | - Michael F. Ofori
- Department of Immunology, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Accra, Ghana
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Al-Jumaili A, Dawood HN, Ikram D, Al-Jabban A. Pneumococcal Disease: Global Disease Prevention Strategies with a Focus on the Challenges in Iraq. Int J Gen Med 2023; 16:2095-2110. [PMID: 37275330 PMCID: PMC10237204 DOI: 10.2147/ijgm.s409476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 05/15/2023] [Indexed: 06/07/2023] Open
Abstract
Pneumococcal disease is a global public health concern that significantly contributes to clinical disease burden and economic burden. Patients frequently afflicted are young children and older adults, as well as the immunocompromised population. Immunization is the most effective public health strategy to combat pneumococcal disease and several vaccine formulations have been developed in this regard. Although vaccines have had a significant global impact in reducing pneumococcal disease, there are several barriers to its success in Iraq. The war and conflict situation, increasing economic crises and poverty, poor vaccine accessibility in the public sector, and high vaccine costs are a few of the major obstacles that impede a successful immunization program. The last reported third dose pneumococcal conjugate vaccine coverage for Iraq was 37% in 2019, which is expected to reduce even further owing to the COVID-19 pandemic. Thus, strategies and policies to improve pneumococcal vaccine availability and coverage need to be strengthened to achieve maximum benefits of immunization. In the current review, we provide an overview of the existing knowledge on pneumococcal disease-prevention strategies across the globe. The main aim of this manuscript is to discuss the current status and challenges of pneumococcal vaccination in Iraq as well as the strategies to prevent pneumococcal infections.
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Affiliation(s)
- Ali Al-Jumaili
- Pediatric Department, Central Pediatric Teaching Hospital, Baghdad, Iraq
| | - Haider N Dawood
- Internal Medicine Department, Al-Imamain Al-Kadhimin Medical City, Baghdad, Iraq
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Abstract
Invasive infections caused by Streptococcus pneumoniae, such as pneumonia, meningitis, and bacteremia, are a major cause of morbidity and mortality in young children and older adults worldwide. The introduction of pneumococcal conjugate vaccines into national childhood immunization programs has led to large and sustained reductions in the incidence of invasive pneumococcal disease across all age groups. Here we describe the epidemiology and biostatistics of pneumococcal disease as well as the impact of vaccination on the burden of pneumococcal disease globally.
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Affiliation(s)
- Godwin Oligbu
- Paediatric Infectious Diseases Research Group, Institute for Infection and Immunity, St. George's, University of London, London, UK.
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, London, UK.
| | - Norman K Fry
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, London, UK
- Respiratory and Vaccine Preventable Bacterial Reference Unit (RVPBRU), National Infection Service Laboratories, Public health England, London, UK
| | - Shamez N Ladhani
- Paediatric Infectious Diseases Research Group, Institute for Infection and Immunity, St. George's, University of London, London, UK
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, London, UK
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Dorji K, Phuntsho S, Pempa, Kumluang S, Khuntha S, Kulpeng W, Rajbhandari S, Teerawattananon Y. Towards the introduction of pneumococcal conjugate vaccines in Bhutan: A cost-utility analysis to determine the optimal policy option. Vaccine 2018; 36:1757-1765. [PMID: 29478752 PMCID: PMC5858152 DOI: 10.1016/j.vaccine.2018.02.048] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 02/09/2018] [Accepted: 02/12/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Due to competing health priorities and limited resources, many low-income countries, even those with a high disease burden, are not able to introduce pneumococcal conjugate vaccines. OBJECTIVE To determine the cost-utility of 10- and 13-valent pneumococcal conjugate vaccines (PCV10 and PCV13) compared to no vaccination in Bhutan. METHODS A model-based cost-utility analysis was performed in the Bhutanese context using a government perspective. A Markov simulation model with one-year cycle length was used to estimate the costs and outcomes of three options: PCV10, PCV13 and no PCV programmes for a lifetime horizon. A discount rate of 3% per annum was applied. Results are presented using an incremental cost-effectiveness ratio (ICER) in United State Dollar per quality-adjusted life year (QALY) gained (USD 1 = Ngultrum 65). A one-way sensitivity analysis and a probabilistic sensitivity analysis were conducted to assess uncertainty. RESULTS Compared to no vaccination, PCV10 and PCV13 gained 0.0006 and 0.0007 QALYs with additional lifetime costs of USD 0.02 and USD 0.03 per person, respectively. PCV10 and PCV13 generated ICERs of USD 36 and USD 40 per QALY gained compared to no vaccination. In addition, PCV13 produced an ICER of USD 92 compared with PCV10. When including PCV into the Expanded Programme on Immunization, the total 5-year budgetary requirement is anticipated to increase to USD. 3.77 million for PCV10 and USD 3.75 million for PCV13. Moreover, the full-time equivalent (FTE) of one health assistant would increase by 2.0 per year while the FTE of other health workers can be reduced each year, particularly of specialist (0.6-1.1 FTE) and nurse (1-1.6 FTE). CONCLUSION At the suggested threshold of 1xGDP per capita equivalent to USD 2708, both PCVs are cost-effective in Bhutan and we recommend that they be included in the routine immunization programme.
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Affiliation(s)
- Kinley Dorji
- Essential Medicine & Technology Division, Ministry of Health, PO Box 726, Thimphu, Bhutan.
| | - Sonam Phuntsho
- Policy & Planning Division, Ministry of Health, PO Box 726, Thimphu, Bhutan.
| | - Pempa
- Essential Medicine & Technology Division, Ministry of Health, PO Box 726, Thimphu, Bhutan.
| | - Suthasinee Kumluang
- Health Intervention and Technology Assessment Program, 6th Floor, 6th Building, Department of Health, Ministry of Public Health, Tiwanon Rd., Muang, Nonthaburi 11000, Thailand.
| | - Sarayuth Khuntha
- Health Intervention and Technology Assessment Program, 6th Floor, 6th Building, Department of Health, Ministry of Public Health, Tiwanon Rd., Muang, Nonthaburi 11000, Thailand.
| | - Wantanee Kulpeng
- Health Intervention and Technology Assessment Program, 6th Floor, 6th Building, Department of Health, Ministry of Public Health, Tiwanon Rd., Muang, Nonthaburi 11000, Thailand.
| | - Sneha Rajbhandari
- Health Intervention and Technology Assessment Program, 6th Floor, 6th Building, Department of Health, Ministry of Public Health, Tiwanon Rd., Muang, Nonthaburi 11000, Thailand.
| | - Yot Teerawattananon
- Health Intervention and Technology Assessment Program, 6th Floor, 6th Building, Department of Health, Ministry of Public Health, Tiwanon Rd., Muang, Nonthaburi 11000, Thailand.
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Nagaraj S, Kalal BS, Manoharan A, Shet A. Streptococcus pneumoniae serotype prevalence and antibiotic resistance among young children with invasive pneumococcal disease: experience from a tertiary care center in South India. Germs 2017. [PMID: 28626738 DOI: 10.18683/germs.2017.1112] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION We performed a study to describe the clinical profile, antimicrobial susceptibility and prevalent serotypes of pneumococcal isolates from children with suspected invasive pneumococcal disease (IPD) admitted to a tertiary care hospital in South India. METHODS Hospitalized children, ≤ 5 years with fever (>38 °C); increased respiratory rate or neurological symptoms were recruited, (as part of the Alliance for Surveillance of Invasive Pneumococci - ASIP - project) from January 2011 to March 2013. Identification of pneumococcal isolates from blood or cerebrospinal fluid samples was done by routine culture methods. Isolates were analyzed for antimicrobial susceptibility, and confirmed by serotyping (using Quellung's test) and multiplex PCR. RESULTS Out of the 171 samples received in the lab, 17 grew pneumococci identified by standard methods. Fourteen of them were confirmed by multiplex PCR. Maximum recruitment was observed during the months of January and February (36.4%, 28.6%). The average age of affected subjects was 21 months. The common clinical presentation was pneumonia (42.8%). Two isolates belonging to the 19F and 19B serotypes were resistant to penicillin (on Etest). The observed serotype distribution was 6B and 19F (2 each), and 1, 2, 6A, 9V, 10A, 14, 15A, 19B, 21, 35F (1 each). The overall fatality rate was 14.3% (n=2); the S. pneumoniae isolates from these two patients belonged to the non-vaccine serotype 19B and vaccine serotype 19F and demonstrated in vitro resistance to penicillin and erythromycin. CONCLUSION Our study demonstrates the presence of invasive pneumococcal disease among under-5-year-old children in India caused by serotypes that are in large part covered by available pneumococcal vaccines.
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Affiliation(s)
- Savitha Nagaraj
- MD, Department of Microbiology, St. John's Medical College Hospital, Bengaluru, 560034, Karnataka, India
| | - Bhuvanesh Sukhlal Kalal
- MSc, Department of Biochemistry, Yenepoya Medical College, Yenepoya University, Mangaluru, 575018, Karnataka, India; and Yenepoya Research Centre, Yenepoya University, Mangaluru, 575018, Karnataka, India
| | - Anand Manoharan
- PhD, Pushpagiri Research Centre, Pushpagiri Institute of Medical Science and Research Centre, Thiruvalla, 689101, Kerala, India
| | - Anita Shet
- MD, PhD, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, 21205, USA
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Uleanya ND. Achieving neonatal tetanus elimination in Nigeria: undisclosed challenges and prospects. Trop Doct 2017; 48:25-30. [DOI: 10.1177/0049475516689538] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
The global initiative for neonatal tetanus elimination was launched in 1989 following the unacceptably high neonatal morbidity and mortality from tetanus. Since then tremendous progress has been made evidenced with a 94% reduction in mortality. Despite this impressive progress, two global target dates have been missed, the latest being in 2005; which led to a further target of 2015 as the global neonatal tetanus elimination date. This target date has probably been missed again as there are still 21 countries yet to be validated. Nigeria is one such country and contributes two-thirds of the burden of neonatal tetanus globally. What are the prospects and challenges of neonatal tetanus elimination in Nigeria? This paper discusses these and other relevant issues regarding neonatal tetanus elimination and sustaining clearance.
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Elshafie S, Taj-Aldeen SJ. Emerging resistant serotypes of invasive Streptococcus pneumoniae. Infect Drug Resist 2016; 9:153-60. [PMID: 27418844 PMCID: PMC4935045 DOI: 10.2147/idr.s102410] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Streptococcus pneumoniae is the leading cause of meningitis and sepsis. The aim of the study was to analyze the distribution, vaccine serotype coverage, and antibiotic resistance of S. pneumoniae serotypes isolated from patients with invasive diseases, after the introduction of pneumococcal 7-valent conjugated vaccine (PCV-7). METHODS A total of 134 isolates were collected from blood and cerebrospinal fluid specimens at Hamad Hospital during the period from 2005 to 2009. Isolate serotyping was done using the Quellung reaction. The prevaccination period was considered before 2005. RESULTS The most common serotypes for all age groups were 3 (12.70%), 14 (11.90%), 1 (11.90%), 19A (9.00%), 9V (5.20%), 23F (5.20%), and 19F (4.50%). Coverage rates for infant <2 years for PCV-7, the 10-valent conjugated vaccine (PCV-10), and the 13-valent conjugated vaccine (PCV-13) were 34.78%, 52.17%, and 78.26%, respectively. Coverage rates of these vaccines were 50%, 67.86%, and 75% for the 2-5 years age group; 27.12%, 40.68%, and 64.41% for the age group 6-64 years; and 25%, 33.33%, and 66.67% for the ≥65 years age group, respectively. The percentage of nonsusceptible isolates to penicillin, cefotaxime, and erythromycin were 43.86%, 16.66%, and 22.81%, respectively. Thirty-seven isolates (32.46%) were multidrug resistant (MDR) and belonged to serotypes 14, 19A, 19F, 23F, 1, 9V, 12F, 4, 6B, 3, and 15A. Compared to previous results before the introduction of PCV-7, there was a significant reduction in penicillin-nonsusceptable S. pneumoniae from 66.67% to 43.86%, and a slight insignificant reduction in erythromycin nonsusceptible strains from 27.60% to 22.8%, while there was a significant increase in cefotaxime nonsusceptible strains from 3.55% to 16.66%. CONCLUSION Invasive pneumococcal strains and the emergence of MDR serotypes is a global burden that must be addressed through multiple strategies, including vaccination, antibiotic stewardship, and continuous surveillance.
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Affiliation(s)
- Sittana Elshafie
- Qatar Orthopedic and Sports Medicine Hospital, Aspetar, Doha, Qatar
- Weill Cornell Medicine-Qatar
| | - Saad J Taj-Aldeen
- Weill Cornell Medicine-Qatar
- Department of Laboratory Medicine and Pathology, Microbiology Division, Hamad Medical Corporation, Doha, Qatar
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Epidemiology of Invasive Pneumococcal Disease in Bangladeshi Children Before Introduction of Pneumococcal Conjugate Vaccine. Pediatr Infect Dis J 2016; 35:655-61. [PMID: 26658530 DOI: 10.1097/inf.0000000000001037] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Because Bangladesh intended to introduce pneumococcal conjugate vaccine (PCV)-10 in 2015, we examined the baseline burden of invasive pneumococcal disease (IPD) to measure impact of PCV. METHODS During 2007-2013, we performed blood and cerebrospinal fluid cultures in children <5 years old with suspected IPD identified through active surveillance at 4 hospitals. Isolates were serotyped by quellung and tested for antibiotic susceptibility by disc diffusion and E-test. Serotyping of culture-negative cases, detected by Binax or polymerase chain reaction, was done by sequential multiplex polymerase chain reaction. Trends in IPD case numbers were analyzed by serotype and clinical syndrome. RESULTS The study identified 752 IPD cases; 78% occurred in children <12 months old. Serotype information was available for 78% (442/568), including 197 of 323 culture-negative cases available for serotyping. We identified 50 serotypes; the most common serotypes were 2 (16%), 1 (10 %), 6B (7%), 14 (7%) and 5 (7%). PCV-10 and PCV-13 serotypes accounted for 46% (range 29%-57% by year) and 50% (range 37%-64% by year) of cases, respectively. Potential serotype coverage for meningitis and nonmeningitis cases was 45% and 49% for PCV-10, and 48% and 57% for PCV-13, respectively. Eighty-two percent of strains were susceptible to all antibiotics except cotrimoxazole. CONCLUSION The distribution of serotypes causing IPD in Bangladeshi children is diverse, limiting the proportion of IPD cases PCV can prevent. However, PCV introduction is expected to have major benefits as the country has a high burden of IPD-related mortality, morbidity and disability.
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Al-Tawfiq JA, Memish ZA. Prevention of pneumococcal infections during mass gathering. Hum Vaccin Immunother 2015; 12:326-30. [PMID: 26176306 DOI: 10.1080/21645515.2015.1058456] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
The interest in mass gathering and its implications has been increasing due to globalization and international travel. The potential occurrence of infectious disease outbreaks during mass gathering is most feared. In this context, respiratory tract infections are of great concern due to crowding in a limited space which facilitates and magnifies the potential of disease spread among attendees. Pneumococcal disease is best described among pilgrims to Makkah and vaccination is one of the methods for the prevention of this disease. Pneumonia was described in a mass gathering with a prevalence of 4.8/100,000 pilgrims and contributes to 15-39% of hospitalizations. Various studies showed that 7-37% of pilgrims are 65 y of age or older. The uptake of pneumococcal vaccine among pilgrims is low at 5%. There is no available data to make strong recommendations for S. pneumoniae vaccination of all pilgrims, it is important that a high risk population receive the indicated vaccination. We reviewed the available literature on the burden of pneumococcal infections during mass gathering and evaluate the available literature on pneumococcal vaccinations for attendees of mass gathering.
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Affiliation(s)
- Jaffar A Al-Tawfiq
- a Johns Hopkins Aramco Healthcare ; Dhahran , Kingdom of Saudi Arabia.,b Indiana University School of Medicine ; Indianapolis , IN USA
| | - Ziad A Memish
- c Ministry of Health and College of Medicine; Alfaisal University ; Riyadh , Saudi Arabia
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Does extreme leukocytosis predict serious bacterial infections in infants in the post-pneumococcal vaccine era? The experience of a large, tertiary care pediatric hospital. Pediatr Emerg Care 2015; 31:391-4. [PMID: 25996230 DOI: 10.1097/pec.0000000000000454] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Extreme leukocytosis, defined as a peripheral white blood cell count greater than 25,000/mm, may alarm clinicians and prompt extensive evaluation in infants with fever, especially in the pediatric emergency department. METHODS We reviewed data from children aged 3 to 36 months with extreme leukocytosis, fever and the risk of serious bacterial infections (SBI) at our institution from July 2010 to December 2012, a period after the universal introduction of pneumococcal vaccine. RESULTS Serious bacterial infection was recorded in 57 (39%) of the 147 infants. The most common SBI were segmental or lobar pneumonia, in 28 (19%) patients, and urinary tract infection in 16 (10.9%) patients. Three patients had positive blood cultures, corresponding to a bacteremia rate of 2%. C-reactive protein was significantly higher in the SBI group than in the non-SBI group. CONCLUSIONS All well-looking febrile infants with white blood cell greater than 25,000/mm should undergo a chest radiograph unless there are clear physical findings that indicate a different etiology. Urine culture should be considered in women. C-reactive protein can have an added value in the differential diagnosis.
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Danuz WA. Epidemiology of invasive Haemophilus influenzae type b disease and the susceptibility of aggregate hosts. J Am Assoc Nurse Pract 2014; 27:114-9. [PMID: 24958314 DOI: 10.1002/2327-6924.12145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2012] [Accepted: 03/04/2013] [Indexed: 11/08/2022]
Abstract
PURPOSE Haemophilus influenzae type b bacteria has been responsible for recent increase in invasive disease in the adult population of the United States. This increase in H. influenzae infections is greatest in individuals above 65 years of age. A plausible explanation for this increase may be the changes observed in the epidemiology of invasive H. influenzae type b (Hib) disease and the susceptibility of aggregate hosts. DATA SOURCES A comprehensive literature review was conducted from multiple data sources, such as PubMed, MEDLINE, CDC, journal articles, reference texts, and Internet websites. CONCLUSIONS The increase in infectious disease caused by H. influenzae type b bacteria is affecting individuals 65 years and older and is preventable. However, Hib vaccines are currently approved for the pediatric population and susceptible adults with certain immune deficiencies. New trends in this invasive disease require reevaluation of current guidelines to include individuals 65 years and older as target population for the polysaccharide Hib vaccine. IMPLICATIONS FOR PRACTICE The changing epidemiology of H. influenzae type b bacteria requires reevaluation of current immunization guidelines regarding Hib vaccination so that it is included in the immunization schedule for adults aged 65 and above.
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Hanieh S, Hamaluba M, Kelly DF, Metz JA, Wyres KL, Fisher R, Pradhan R, Shakya D, Shrestha L, Shrestha A, Joshi A, Habens J, Maharjan BD, Thorson S, Bohler E, Yu LM, Kelly S, Plested E, John T, Werno AM, Adhikari N, Murdoch DR, Brueggemann AB, Pollard AJ. Streptococcus pneumoniae carriage prevalence in Nepal: evaluation of a method for delayed transport of samples from remote regions and implications for vaccine implementation. PLoS One 2014; 9:e98739. [PMID: 24905574 PMCID: PMC4048273 DOI: 10.1371/journal.pone.0098739] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2013] [Accepted: 05/07/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Pneumococcal disease is a significant cause of morbidity and mortality in young children in Nepal, and currently available pneumococcal conjugate vaccines offer moderate coverage of invasive disease isolates. METHODS A prevalence study of children aged 1.5 to 24 months in urban and rural Nepal was conducted. In the urban group, nasopharyngeal swabs (NPS) were transported using silica desiccant packages (SDP) with delayed processing (2 weeks), or skim-milk-tryptone-glucose-glycerin (STGG) with immediate processing (within 8 hours). Pneumococcal nasopharyngeal carriage prevalence, serogroup/type distribution and isolate genotypes (as defined by multilocus sequence typing) were determined. RESULTS 1101 children were enrolled into the study: 574 in the urban group and 527 in the rural group. Overall carriage prevalence based on culture from specimens transported and stored in STGG was 58.7% (337/574), compared to 40.9% (235/574) in SDP. There was concordance of detection of pneumococcus in 67% of samples. Using the SDP method, pneumococcal carriage prevalence was higher in the rural population (69.2%; 364/526) compared to the urban population (40.9%; 235/574). Serogroup/type distribution varied with geographical location. Over half of the genotypes identified in both the urban and rural pneumococcal populations were novel. CONCLUSION The combination of delayed culture and transport using SDP underestimates the prevalence of pneumococcal carriage; however, in remote areas, this method could still provide a useful estimate of carriage prevalence and serogroup/type distribution. Vaccine impact is unpredictable in a setting with novel genotypes and limited serotype coverage as described here. Consequently, continued surveillance of pneumococcal isolates from carriage and disease in Nepali children following the planned introduction of pneumococcal conjugate vaccines introduction will be essential.
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Affiliation(s)
- Sarah Hanieh
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, and the NIHR Oxford Biomedical Research Centre, Oxford, United Kingdom
- Patan Academy Paediatric Research Unit, Patan Academy of Health Sciences, Kathmandu, Nepal
| | - Mainga Hamaluba
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, and the NIHR Oxford Biomedical Research Centre, Oxford, United Kingdom
- Patan Academy Paediatric Research Unit, Patan Academy of Health Sciences, Kathmandu, Nepal
| | - Dominic F. Kelly
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, and the NIHR Oxford Biomedical Research Centre, Oxford, United Kingdom
| | - Jane A. Metz
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, and the NIHR Oxford Biomedical Research Centre, Oxford, United Kingdom
- Patan Academy Paediatric Research Unit, Patan Academy of Health Sciences, Kathmandu, Nepal
| | - Kelly L. Wyres
- Department of Zoology, University of Oxford, Oxford, United Kingdom
| | - Roberta Fisher
- Department of Zoology, University of Oxford, Oxford, United Kingdom
| | - Rahul Pradhan
- Patan Academy Paediatric Research Unit, Patan Academy of Health Sciences, Kathmandu, Nepal
| | - Disuja Shakya
- Patan Academy Paediatric Research Unit, Patan Academy of Health Sciences, Kathmandu, Nepal
| | - Lochan Shrestha
- Patan Academy Paediatric Research Unit, Patan Academy of Health Sciences, Kathmandu, Nepal
| | - Amrita Shrestha
- Patan Academy Paediatric Research Unit, Patan Academy of Health Sciences, Kathmandu, Nepal
| | - Anip Joshi
- Patan Academy Paediatric Research Unit, Patan Academy of Health Sciences, Kathmandu, Nepal
| | - Jocelyn Habens
- Patan Academy Paediatric Research Unit, Patan Academy of Health Sciences, Kathmandu, Nepal
| | - Bishnu D. Maharjan
- Patan Academy Paediatric Research Unit, Patan Academy of Health Sciences, Kathmandu, Nepal
| | - Stephen Thorson
- Patan Academy Paediatric Research Unit, Patan Academy of Health Sciences, Kathmandu, Nepal
| | - Erik Bohler
- Okhaldhunga Community Hospital, Okhaldhunga, Nepal
| | - Ly-Mee Yu
- Nuffield Department of Primary Care and Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Sarah Kelly
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, and the NIHR Oxford Biomedical Research Centre, Oxford, United Kingdom
| | - Emma Plested
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, and the NIHR Oxford Biomedical Research Centre, Oxford, United Kingdom
| | - Tessa John
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, and the NIHR Oxford Biomedical Research Centre, Oxford, United Kingdom
| | - Anja M. Werno
- Department of Pathology, University of Otago, Christchurch, New Zealand
- Canterbury Health Laboratories, Christchurch, New Zealand
| | - Neelam Adhikari
- Patan Academy Paediatric Research Unit, Patan Academy of Health Sciences, Kathmandu, Nepal
| | - David R. Murdoch
- Department of Pathology, University of Otago, Christchurch, New Zealand
- Canterbury Health Laboratories, Christchurch, New Zealand
| | | | - Andrew J. Pollard
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, and the NIHR Oxford Biomedical Research Centre, Oxford, United Kingdom
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14
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Qureishi A, Lee Y, Belfield K, Birchall JP, Daniel M. Update on otitis media - prevention and treatment. Infect Drug Resist 2014; 7:15-24. [PMID: 24453496 PMCID: PMC3894142 DOI: 10.2147/idr.s39637] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Acute otitis media and otitis media with effusion are common childhood disorders, a source of significant morbidity, and a leading cause of antibiotic prescription in primary health care. Although effective treatments are available, some shortcomings remain, and thus better treatments would be welcome. Recent discoveries within the field of otitis media research relating to its etiology and pathogenesis have led to further investigation aimed at developing novel treatments. This article provides a review of the latest evidence relating to the understanding of acute otitis media and otitis media with effusion, current treatment strategies, their limitations, new areas of research, and novel strategies for treatment.
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Affiliation(s)
- Ali Qureishi
- Otolaryngology Head and Neck Surgery, Northampton General Hospital, Northampton, UK
| | - Yan Lee
- NIHR Nottingham Hearing Biomedical Research Unit, Nottingham, UK
| | | | - John P Birchall
- Otorhinolaryngology Head and Neck Surgery, The University of Nottingham, Nottingham, UK
| | - Matija Daniel
- NIHR Nottingham Hearing Biomedical Research Unit, Nottingham, UK
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15
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Microbiology of acute mastoiditis and complicated or refractory acute otitis media among hospitalized children in the postvaccination era. Pediatr Infect Dis J 2014; 33:111-3. [PMID: 23897291 DOI: 10.1097/inf.0b013e3182a6adb7] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In the post-heptavalent pneumococcal conjugate vaccine era, Streptococcus pneumoniae remains the leading cause of acute mastoiditis and other complicated or refractory acute otitis media among hospitalized children in our settings. Serotype 19A is predominant, invasive and multidrug resistant causing more than half of all mastoiditis cases, two-thirds of cases with subperiosteal abscess and all those requiring mastoidectomy. Continuous surveillance is required.
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16
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Esposito S, Musio A, Principi N. Paediatric asthma and pneumococcal vaccination. Vaccine 2013; 31:5015-9. [PMID: 24021307 DOI: 10.1016/j.vaccine.2013.08.090] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2013] [Revised: 08/24/2013] [Accepted: 08/28/2013] [Indexed: 11/26/2022]
Abstract
Asthma is a clinical condition that has only recently been considered a risk factor for the development of pneumococcal infections. In the most recent guidelines concerning the use of pneumococcal vaccines, the Advisory Committee on Immunisation Practices recommends pneumococcal vaccination only when children with asthma aged <71 months are treated with high-dose corticosteroids, whereas the same Committee clearly indicates that asthma (without any definition of severity or treatment) is a reason for systematic pneumococcal vaccination in adults. It is also unclear which pneumococcal vaccine should be used and how to face the problem of booster doses. The main aim of this paper is to describe what is known about the real risk of pneumococcal infections in children with asthma, and discuss the unsolved problems regarding the paediatric use of pneumococcal vaccines. There are few published data regarding pneumococcal colonisation and the burden of pneumococcal disease in asthmatic children and adolescents, and none at all concerning the relationship between paediatric asthma and immune responses to pneumococcal vaccines. Further studies are therefore essential to assure that children and adolescents with asthma receive the best protection against pneumococcal diseases.
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Affiliation(s)
- Susanna Esposito
- Pediatric High Intensity Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
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17
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Jacobs MR. Antimicrobial-resistant Streptococcus pneumoniae: trends and management. Microb Drug Resist 2013. [DOI: 10.2217/ebo.12.366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Michael R Jacobs
- Michael R Jacobs obtained his medical degree and doctorate in medical microbiology from the University of the Witwatersrand in Johannesburg, South Africa. He is currently Professor of Pathology and Medicine at Case Western Reserve University (OH, USA) and Director of Clinical Microbiology at University Hospitals Case Medical Center (OH, USA). His interests include: the study of antibiotic-resistant Streptococcus pneumoniae; the microbiology, epidemiology and antimicrobial susceptibility of respiratory
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18
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The impact of 7-valent pneumococcal conjugate vaccine on invasive pneumococcal disease: a literature review. Adv Ther 2013; 30:127-51. [PMID: 23397399 DOI: 10.1007/s12325-013-0007-6] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Streptococcus pneumoniae can cause invasive pneumococcal diseases (IPD), such as bacteremic pneumonia, bacteremia, meningitis, and sepsis, and non-IPDs, such as otitis media, nonbacteremic pneumonia, and upper respiratory tract infections. It was estimated in 2000 that, worldwide, S. pneumoniae was responsible for 826,000 deaths annually in children aged between 1 month and 5 years. A 7-valent pneumococcal conjugate vaccine (PCV7) was licensed in 2000 in the USA and in 2001 in Europe. METHODS A literature search was performed in PubMed to identify studies assessing the impact of routine childhood PCV7 vaccination on pneumococcal morbidity and mortality. Here, the impact on IPD is reported. RESULTS A total of 37 articles reporting impact data on IPD were included in this review: four from Australia, 17 from western Europe, and 16 from North America. In vaccine-eligible children in the postvaccination period, a reduction ranging from 39.9% in Spain to 99.1% in the USA in vaccine-type (VT) IPD incidence, compared with the prevaccination period, was reported in 18 studies. All but one of the 30 studies assessing the impact of PCV7 on all-type IPD reported a reduction ranging from 1.7% in Spain to 76.3% in Australia. In addition, the majority of studies reported reductions in VT and all-type IPD incidence in age groups that were not vaccine eligible. CONCLUSIONS The results from this review illustrate that PCV7 has had a significant impact on IPD across all ages through its use in pediatric immunization programs. With the introduction of 13-valent pneumococcal conjugate vaccine (PCV13) further reductions in the incidence of IPD due to the six additional serotypes included, as well as continued protection against IPD due to PCV7 serotypes may be expected. Robust surveillance systems are essential for the evaluation of the impact of PCV13 on all-type IPD and for monitoring the evolution of non-VT IPD.
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19
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Mehr S, Wood N. Streptococcus pneumoniae--a review of carriage, infection, serotype replacement and vaccination. Paediatr Respir Rev 2012; 13:258-64. [PMID: 23069126 DOI: 10.1016/j.prrv.2011.12.001] [Citation(s) in RCA: 102] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Invasive pneumococcal infection remains a leading global cause of morbidity and mortality in young children. In developed nations, a substantial decrease in the incidence of IPD has been achieved with inclusion of the 7 valent protein conjugated pneumococcal vaccines (7vPCV) into paediatric vaccine schedules. In contrast, the incidence of IPD has changed little in developing nations. This is likely due to poor access to medical care and pneumococcal vaccination, the accompanying HIV and malnutrition burden, and the fact that 7vPCV does not contain the most common serotypes (1,5, 6A) responsible for IPD in many developing nations. The battle against IPD in developed nations is not over, with the rise of non-7vPCV serotypes since routine 7vPCV vaccination. This has necessitated the development and distribution of pneumococcal vaccines containing 3 or 6 additional serotypes. This article provides an overview on pneumococcal carriage and risk factors for IPD, the rise of non-7vCPV serotypes in the era of 7vPCV vaccination, and the current and newly available broader valent pneumococcal vaccines.
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Affiliation(s)
- Sam Mehr
- Department of Immunology and Allergy, The Children's Hospital at Westmead, Sydney, Australia.
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20
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What effect has pneumococcal vaccination had on acute mastoiditis? The Journal of Laryngology & Otology 2012. [PMID: 23186827 DOI: 10.1017/s0022215112002654] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Streptococcus pneumoniae is a frequent cause of acute mastoiditis. Despite the recent (2005) introduction of pneumococcal vaccination, mastoiditis incidence and severity may be increasing. This study aimed to assess the incidence, severity and microbiology of acute mastoiditis over an 11-year period. METHODS Retrospective review of paediatric acute mastoiditis cases seen at our institution (2000-2010), comparing patients seen prior to vaccination introduction (period one, 2000-2004), around the time of vaccine introduction (period two, 2005-2007) and post-vaccination (period three, 2008-2010). RESULTS We reviewed 84 children. In periods one, two and three, respectively: mean annual case load was 8.4, 5 and 9 children; pneumococcal isolates were seen in 40.5, 6.7 and 29.6 per cent of cases; highest recorded fever was 38.6, 38.9 and 38.2°C and highest leukocyte count 18.9, 15.0 and 15.6 × 109/l; incidence of intracranial complications was 11.9, 0 and 7.4 per cent; mean duration of intravenous antibiotics was 6.0, 4.1 and 4.2 days; proportion treated surgically was 71.4, 60.0 and 48.1 per cent; and mean length of in-patient stay shortened. CONCLUSION Pneumococcal mastoiditis admission rates appeared to fall when vaccination was introduced, with concomitant reduction in overall mastoiditis incidence and intracranial complications; subsequently, however, admission rates rapidly returned to pre-vaccination levels.
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21
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Pittet LF, Posfay-Barbe KM. Pneumococcal vaccines for children: a global public health priority. Clin Microbiol Infect 2012; 18 Suppl 5:25-36. [PMID: 22862432 DOI: 10.1111/j.1469-0691.2012.03938.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Pneumococcal conjugated vaccines have been recommended in children for over a decade in many countries worldwide. Here we review the development of pneumococcal vaccines with a focus on the two types currently available for children and their safety record. We discuss also the effect of vaccines, including the 13-valent pneumococcal conjugate vaccine, on invasive pneumococcal diseases in children, particularly bacteraemia, pneumonia and meningitis, as well as on mucosal disease and carriage. In regions where immunization was implemented in young children, the number of invasive pneumococcal diseases decreased significantly, not only in the target age group, but also in younger and much older subjects. Challenges and future perspectives regarding the development of new 'universal' vaccines, which could bypass the current problem of serotype-specific protection in a context of serotype replacement, are also discussed.
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Affiliation(s)
- L F Pittet
- Department of Paediatrics, Geneva University Hospitals and University of Geneva Medical School, Geneva, Switzerland
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22
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Abstract
BACKGROUND Pneumococcal conjugate vaccines (PCV) are emerging as one of the most promising means to prevent pediatric disease. The 7-valent PCV (PCV-7) has been extensively evaluated in clinical trials, and recent evidence from the introduction of PCV-7 through national immunization programs has demonstrated impact on pneumococcal disease. METHODS Clinical trials have shown PCV-7 to be effective against the more severe forms of pneumococcal infections: pneumonia and invasive pneumococcal disease (IPD), as well as overall child mortality. A review shows the tremendous impact PCV-7 has had to date, and the potential further benefits of the emerging multi-valent vaccines. RESULTS Since its introduction, the PCV-7 has substantially reduced the incidence of IPD, hospital admissions due to pneumonia and acute otitis media in numerous, mostly high income, low-disease burden countries. The reductions in IPD and pneumonia have also been observed among unvaccinated age groups in countries with routine use of PCV-7, demonstrating that PCV-7 provides herd immunity. Some settings observed an increase in rate of nonvaccine serotype IPD, yet rates of overall and vaccine-serotype IPD show marked reductions post-PCV-7 introduction. Limited data are available on the impact of PCV-7 in lower income countries. The available data from efficacy trials from The Gambia and South Africa suggest that PCV-7 will have substantial impact on reducing pneumococcal disease. CONCLUSION PCV-7 has shown dramatic reduction in disease and mortality rates in the countries in which it has been introduced. The newly introduced 10-valent and 13-valent pneumococcal vaccines are expected to have substantial disease impact, but monitoring is essential to determine their true impact and sustain further introduction of pneumococcal conjugate vaccines.
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23
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Vila-Corcoles A, Ochoa-Gondar O, Gomez-Bertomeu F, Raga-Luria X. Invasive pneumococcal disease in Catalonian elderly people, 2002–2009: Serotype coverage for different anti-pneumococcal vaccine formulations at the beginning of the new conjugate vaccines era. Vaccine 2011; 29:7430-4. [DOI: 10.1016/j.vaccine.2011.07.066] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2011] [Revised: 06/30/2011] [Accepted: 07/17/2011] [Indexed: 10/17/2022]
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Ochoa-Gondar O, Vila-Corcoles A. Incidence of invasive pneumococcal disease among elderly people in Southern Catalonia, Spain, 2002-2009: an increase in serotypes not contained in the heptavalent conjugate vaccine. J Infect 2011; 63:434-40. [PMID: 21875616 DOI: 10.1016/j.jinf.2011.08.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2011] [Revised: 07/09/2011] [Accepted: 08/21/2011] [Indexed: 11/29/2022]
Abstract
Population-based surveillance study conducted among persons ≥ 65 years old in Southern Catalonia, Spain during 2002-2009. All cases with isolation of pneumococcus from normally sterile bodily fluids were included. Incidence rates of invasive pneumococcal disease (IPD) as well as rates of infections caused by serotypes included in the heptavalent pneumococcal conjugate vaccine (PCV7) and the 23-valent polysaccharide pneumococcal vaccine (PPV23) were compared for early (2002-2005) and contemporary (2006-2009) periods. Mean incidence rate (per 100,000 population-year) of IPD across study period was 48.0 [95% CI (confidence interval): 30.1-72.5]. Incidence rates for PCV7 serotypes slightly decreased by 21% between 2002-2005 and 2006-2009 (from 9.2 to 7.3; p = 0.511) whereas rates of IPD due to nonPCV7 serotypes largely increased by 172% (from 15.6 to 42.4; p < 0.001) during the same period. For PPV23 but nonPCV7 types, incidence rates increased by 146% (from 10.9 to 26.9; p < 0.001) whereas rates for nonPPV23 serotypes increased by 237% (from 4.6 to 15.5; p = 0.001). As an overall effect of these changes, the incidence of all IPD increased by a significant 69% (95% CI: 29%-110%). Specific incidence rates of serotypes 6A (from 1.7 to 4.1; p = 0.182), 7F (from 1.7 to 5.7; p = 0.052) and 19A (from 0.6 to 6.2; p = 0.004) substantially increased between both periods. According to these findings, Southern Catalonia region can be classified as a mesoendemic area of pneumococcal infections among elderly people, with a recent increase incidence of some nonPCV7 serotypes (especially 19A).
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Affiliation(s)
- Olga Ochoa-Gondar
- Primary Care Service of Tarragona-Valls, EPIVAC Study Group, Institut Catala de la Salut, Av Prat de la Riba 39, 43001 Tarragona, Spain.
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