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Pan D, Nielsen E, Chung S, Niederman MS. Management of pneumonia in the critically ill. Minerva Med 2023; 114:667-682. [PMID: 36700925 DOI: 10.23736/s0026-4806.22.08467-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Pneumonias continue to be major public health issues and are commonly encountered in the intensive care setting. The most common types of pneumonia leading to critical illness include severe community acquired pneumonia, hospital acquired pneumonia, and ventilator associated pneumonia. Early evaluation, diagnosis, and escalation to appropriate levels of care are imperative to improving survival. Treatment remains challenging with the need to balance antibiotic stewardship and minimizing patient harm. As evidenced in the most recent society guidelines, the identification of risk factors for severe disease and the causative pathogens are crucial in guiding the most appropriate therapy.
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Affiliation(s)
- Di Pan
- Division of Pulmonary and Critical Care Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Erik Nielsen
- Division of Pulmonary and Critical Care Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Samuel Chung
- Division of Pulmonary and Critical Care Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Michael S Niederman
- Division of Pulmonary and Critical Care Medicine, Weill Cornell Medical College, New York, NY, USA -
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Janssens A, Vaes B, Abels C, Crèvecoeur J, Mamouris P, Merckx B, Libin P, Van Pottelbergh G, Neyens T. Pneumococcal vaccination coverage and adherence to recommended dosing schedules in adults: a repeated cross-sectional study of the INTEGO morbidity registry. BMC Public Health 2023; 23:1104. [PMID: 37286969 DOI: 10.1186/s12889-023-15939-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 05/19/2023] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND Since 2014, Belgium's Superior Health Council has recommended pneumococcal vaccination for adults aged 19-85 years at increased risk for pneumococcal diseases with a specific vaccine administration sequence and timing. Currently, Belgium has no publicly funded adult pneumococcal vaccination program. This study investigated the seasonal pneumococcal vaccination trends, evolution of vaccination coverage and adherence to the 2014 recommendations. METHODS INTEGO is a general practice morbidity registry in Flanders (Belgium) that represents 102 general practice centres and comprised over 300.000 patients in 2021. A repeated cross-sectional study was performed for the period between 2017 and 2021. Using adjusted odds ratios computed via multiple logistic regression, the association between an individual's characteristics (gender, age, comorbidities, influenza vaccination status and socioeconomic status) and schedule-adherent pneumococcal vaccination status was assessed. RESULTS Pneumococcal vaccination coincided with seasonal flu vaccination. The vaccination coverage in the population at risk decreased from 21% in 2017 to 18.2% in 2018 and then started to increase to 23.6% in 2021. Coverage in 2021 was highest for high-risk adults (33.8%) followed by 50- to 85-year-olds with comorbidities (25.5%) and healthy 65- to 85-year-olds (18.7%). In 2021, 56.3% of the high-risk adults, 74.6% of the 50+ with comorbidities persons, and 74% of the 65+ healthy persons had an adherent vaccination schedule. Persons with a lower socioeconomic status had an adjusted odds ratio of 0.92 (95% Confidence Interval (CI) 0.87-0.97) for primary vaccination, 0.67 (95% CI 0.60-0.75) for adherence to the recommended second vaccination if the 13-valent pneumococcal conjugate vaccine was administered first and 0.86 (95% CI 0.76-0.97) if the 23-valent pneumococcal polysaccharide vaccine was administered first. CONCLUSION Pneumococcal vaccine coverage is slowly increasing in Flanders, displaying seasonal peaks in sync with influenza vaccination campaigns. However, with less than one-fourth of the target population vaccinated, less than 60% high-risk and approximately 74% of 50 + with comorbidities and 65+ healthy persons with an adherent schedule, there is still much room for improvement. Furthermore, adults with poor socioeconomic status had lower odds of primary vaccination and schedule adherence, demonstrating the need for a publicly funded program in Belgium to ensure equitable access.
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Affiliation(s)
- Arne Janssens
- Department of Public Health and Primary Care, Faculty of Medicine, Academic Centre of General Practice, KU Leuven, Kapucijnenvoer 35, Leuven, B-3000, Belgium.
| | - Bert Vaes
- Department of Public Health and Primary Care, Faculty of Medicine, Academic Centre of General Practice, KU Leuven, Kapucijnenvoer 35, Leuven, B-3000, Belgium
| | | | - Jonas Crèvecoeur
- I-BioStat, Data Science Institute, Hasselt University, Martelarenlaan 42, B-3500, Hasselt, Belgium
| | - Pavlos Mamouris
- Department of Public Health and Primary Care, Faculty of Medicine, Academic Centre of General Practice, KU Leuven, Kapucijnenvoer 35, Leuven, B-3000, Belgium
| | | | - Pieter Libin
- Interuniversity Institute of Biostatistics and Statistical Bioinformatics, Data Science Institute, Hasselt University, Hasselt, Belgium
- Artificial Intelligence Lab, Department of Computer Science, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Microbiology and Immunology, Rega Institute for Medical Research, Clinical and Epidemiological Virology, KU Leuven, Leuven, Belgium
| | - Gijs Van Pottelbergh
- Department of Public Health and Primary Care, Faculty of Medicine, Academic Centre of General Practice, KU Leuven, Kapucijnenvoer 35, Leuven, B-3000, Belgium
| | - Thomas Neyens
- I-BioStat, Data Science Institute, Hasselt University, Martelarenlaan 42, B-3500, Hasselt, Belgium
- Department of Public Health and Primary Care, Faculty of Medicine, L-BioStat, KU Leuven, Kapucijnenvoer 35, Leuven, B-3000, Belgium
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3
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Wennekes MD, Eilers R, Caputo A, Gagneux-Brunon A, Gavioli R, Nicoli F, Vokó Z, Timen A. Focus group study on perceptions and information needs regarding vaccines targeting the older population: a cross-country comparison in four European countries. GeroScience 2022; 45:871-887. [PMID: 36413259 PMCID: PMC9684753 DOI: 10.1007/s11357-022-00682-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 10/26/2022] [Indexed: 11/23/2022] Open
Abstract
The increasing life expectancy leads to more older adults suffering from infectious diseases. Vaccines are available against diverse infections such as influenza, pneumococcal disease, herpes zoster and tetanus. However, vaccine acceptance is crucial for optimal preventive effect. The objective of the study is to perform a cross-country analysis of the perceptions and decision-making behaviour of older adults regarding vaccinations and their information needs. Focus groups with older adults were conducted in four countries: France, Hungary, Italy and the Netherlands. Data were analysed using thematic analysis. Demographic characteristics of participants were gathered with a questionnaire. Influenza and tetanus vaccines were commonly known, as was the disease influenza. On the contrary, the awareness of the vaccines against pneumococcal disease and herpes zoster were low. Participants also expressed a need for more information on vaccines, such as possible side effects, contra-indications and duration of protection, emphasizing that information is a condition for decision-making on vaccination. General practitioners were found to be the most important in information provision on vaccines. Perceptions on vaccines, such as effectiveness, side effects and safety, as well as perceptions on infectious diseases, such as severity, susceptibility and experiencing an infectious disease, played a role in the decision-making of older adults on vaccines. More awareness of the information needs among older adults with regard to vaccines should be raised among general practitioners and other healthcare providers. This requires appropriate knowledge about the vaccines among healthcare providers as well as communication skills to meet the information needs of older adults.
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Affiliation(s)
- Manuela Dominique Wennekes
- National Coordination Centre for Communicable Disease Control, National Institute of Public Health and the Environment (RIVM), Bilthoven, the Netherlands.
- Athena Institute, VU University Amsterdam, Amsterdam, the Netherlands.
| | - Renske Eilers
- National Coordination Centre for Communicable Disease Control, National Institute of Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Antonella Caputo
- Department of Chemical, Pharmaceutical and Agricultural Sciences, University of Ferrara, Ferrara, Italy
| | - Amandine Gagneux-Brunon
- Centre International de Recherche en Infectiologie, Team GIMAP, INSERM, U1111, CNRS, UMR530, Université de Lyon, Saint-Etienne, France
- Department of infectious Diseases, University Hospital of Saint-Etienne, Saint-Etienne, France
- Chaire PreVacCI, Université Jean Monnet, Saint-Etienne, France
- CIC-INSERM 1408 Vaccinologie, CHU de Saint-Etienne, Université Jean Monnet, Saint-Etienne, France
| | - Riccardo Gavioli
- Department of Chemical, Pharmaceutical and Agricultural Sciences, University of Ferrara, Ferrara, Italy
| | - Francesco Nicoli
- Department of Chemical, Pharmaceutical and Agricultural Sciences, University of Ferrara, Ferrara, Italy
| | - Zoltán Vokó
- Syreon Research Institute, Budapest, Hungary
- Center for Health Technology Assessment, Semmelweis University, Budapest, Hungary
| | - Aura Timen
- National Coordination Centre for Communicable Disease Control, National Institute of Public Health and the Environment (RIVM), Bilthoven, the Netherlands
- Athena Institute, VU University Amsterdam, Amsterdam, the Netherlands
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, the Netherlands
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Zens KD, Baroutsou V, Fehr JS, Lang P. Pneumococcal Vaccination Coverage and Uptake Among Adults in Switzerland: A Nationwide Cross-Sectional Study of Vaccination Records. Front Public Health 2022; 9:759602. [PMID: 35174130 PMCID: PMC8841552 DOI: 10.3389/fpubh.2021.759602] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 12/21/2021] [Indexed: 01/18/2023] Open
Abstract
Streptococcus pneumoniae, or pneumococcus, is a common, opportunistic pathogen which can cause severe disease, particularly in adults 65+. In Switzerland, vaccination is recommended for children under 5 and for adults with health predispositions; vaccination of healthy adults 65+ is not recommended. In 2020 we conducted a nationwide, cross-sectional survey of vaccination records to evaluate pneumococcal vaccination coverage and factors affecting uptake among adults 18–85. We found that nationwide coverage was 4.5% without significant regional differences. Coverage was comparable between men and women and between those aged 18–39 (3.0%) and 40–64 (3.2%). Coverage was significantly higher among those 65–85 (9.6%). While 2.7% of individuals reporting no health predisposition were vaccinated, 14.8% with asthma or chronic pulmonary disease, 27.1% with immunosuppression, 12.9% with diabetes, 11.6% with heart, liver, or kidney disease, and 25.9% with >1 health risk were vaccinated. Adjusted odds of vaccination for all health predispositions except heart, liver, or kidney disease were significantly increased. Among unvaccinated individuals “not enough information about the topic” and “not suggested by a doctor/healthcare provider” were the major reasons for abstaining from vaccination. Respondents reporting a health predisposition were significantly less likely to report “not at increased risk due to chronic health conditions or age” as a reason for not being vaccinated (3.7% vs. 29.1%) and were more likely to report willingness to be vaccinated in the future compared to those not-at-risk (54.2% vs. 39.9%). Our results indicate that pneumococcal vaccination coverage in Switzerland is low among both individuals 65–85 and among those with predisposing health risks. It appears that at-risk individuals are aware of their increased risk, but feel they do not have enough information on the topic to seek vaccination, or have not been recommended a vaccination by their physician.
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Affiliation(s)
- Kyra D. Zens
- Department of Public and Global Health, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
- Department of Viral Immunobiology, Institute for Experimental Immunology, University of Zurich, Zurich, Switzerland
| | - Vasiliki Baroutsou
- Department of Public and Global Health, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
- Department of Clinical Research, Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Jan S. Fehr
- Department of Public and Global Health, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
- University Hospital, University of Zurich, Zurich, Switzerland
| | - Phung Lang
- Department of Public and Global Health, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
- *Correspondence: Phung Lang
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5
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Vetrano DL, Triolo F, Maggi S, Malley R, Jackson TA, Poscia A, Bernabei R, Ferrucci L, Fratiglioni L. Fostering healthy aging: The interdependency of infections, immunity and frailty. Ageing Res Rev 2021; 69:101351. [PMID: 33971332 PMCID: PMC9588151 DOI: 10.1016/j.arr.2021.101351] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 04/16/2021] [Accepted: 05/03/2021] [Indexed: 12/20/2022]
Abstract
Untangling the interdependency of infections, immunity and frailty may help to clarify their roles in the maintenance of health in aging individuals, and the recent COVID-19 pandemic has further highlighted such priority. In this scoping review we aimed to systematically collect the evidence on 1) the impact of common infections such as influenza, pneumonia and varicella zoster on frailty development, and 2) the role played by frailty in the response to immunization of older adults. Findings are discussed under a unifying framework to identify knowledge gaps and outline their clinical and public health implications to foster a healthier aging. Twenty-nine studies (113,863 participants) selected to answer the first question provided a moderately strong evidence of an association between infections and physical as well as cognitive decline - two essential dimensions of frailty. Thirteen studies (34,520 participants) investigating the second aim, showed that frailty was associated with an impaired immune response in older ages, likely due to immunosenescence. However, the paucity of studies, the absence of tools to predict vaccine efficacy, and the lack of studies investigating the efficacy of newer vaccines in presence of frailty, strongly limit the formulation of more personalized immunization strategies for older adults. The current evidence suggests that infections and frailty repeatedly cross each other pathophysiological paths and accelerate the aging process in a vicious circle. Such evidence opens to several considerations. First, the prevention of both conditions pass through a life course approach, which includes several individual and societal aspects. Second, the maintenance of a well-functioning immune system may be accomplished by preventing frailty, and vice versa. Third, increasing the adherence to immunization may delay the onset of frailty and maintain the immune system homeostasis, beyond preventing infections.
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Affiliation(s)
- Davide L Vetrano
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Centro Medicina dell'Invecchiamento, Fondazione Policlinico "A- Gemelli" IRCCS and Catholic University of Rome, Italy.
| | - Federico Triolo
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Stefania Maggi
- National Research Council, Neuroscience Institute, Padua, Italy
| | - Richard Malley
- Division of Infectious Diseases, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Thomas A Jackson
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK; Department of Geriatrics, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Roberto Bernabei
- Centro Medicina dell'Invecchiamento, Fondazione Policlinico "A- Gemelli" IRCCS and Catholic University of Rome, Italy
| | - Luigi Ferrucci
- Longitudinal Studies Section, Translational Gerontology Branch, National Institute on Aging, National Institutes of Health, Baltimore, USA
| | - Laura Fratiglioni
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Stockholm Gerontology Research Center, Stockholm, Sweden
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Abstract
Pneumonia is a common acute respiratory infection that affects the alveoli and distal airways; it is a major health problem and associated with high morbidity and short-term and long-term mortality in all age groups worldwide. Pneumonia is broadly divided into community-acquired pneumonia or hospital-acquired pneumonia. A large variety of microorganisms can cause pneumonia, including bacteria, respiratory viruses and fungi, and there are great geographical variations in their prevalence. Pneumonia occurs more commonly in susceptible individuals, including children of <5 years of age and older adults with prior chronic conditions. Development of the disease largely depends on the host immune response, with pathogen characteristics having a less prominent role. Individuals with pneumonia often present with respiratory and systemic symptoms, and diagnosis is based on both clinical presentation and radiological findings. It is crucial to identify the causative pathogens, as delayed and inadequate antimicrobial therapy can lead to poor outcomes. New antibiotic and non-antibiotic therapies, in addition to rapid and accurate diagnostic tests that can detect pathogens and antibiotic resistance will improve the management of pneumonia.
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Hu Y, Liu Y, Yin Y, Zhang X. Protective efficacy of mucosal and subcutaneous immunization with DnaJ-ΔA146Ply against influenza and Streptococcus pneumoniae co-infection in mice. Microbes Infect 2021; 23:104813. [PMID: 33798714 DOI: 10.1016/j.micinf.2021.104813] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 03/09/2021] [Accepted: 03/16/2021] [Indexed: 02/02/2023]
Abstract
Respiratory tract coinfections, specifically involving influenza A virus (IAV) and Streptococcus pneumoniae (S. pneumoniae), remain a major health problem worldwide. Secondary bacterial pneumonia is a common complication and an important cause of mortality related to seasonal and pandemic influenza infections. Vaccination is a basic control strategy against influenza and S. pneumoniae. The fusion protein DnaJ-ΔA146Ply is a vaccine candidate which can induce immune responses against pneumococcal infections via mucosal and subcutaneous immunization in mice. In the present study, we established a co-infection model using mouse-adapted laboratory strains of IAV (PR8) and S. pneumoniae (19F) in mice intranasally and subcutaneously immunized with DnaJ-ΔA146Ply. Our results showed that vaccinated mice suffered decreased weight loss compared with control mice. The survival rates were higher in intranasally and subcutaneously immunized mice than in control mice. In addition, the bacterial loads in nasal washes and lung homogenates were lower in vaccinated mice than in control mice. Furthermore, lung damage was alleviated in vaccinated mice compared with control mice, with less broken alveoli and less proinflammatory cytokine production. Taken together, these results indicate that vaccination with DnaJ-ΔA146Ply shows protective potential against influenza and S. pneumoniae co-infection in mice.
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Affiliation(s)
- Yi Hu
- Department of Laboratory Medicine, Key Laboratory of Diagnostic Medicine (Ministry of Education), Chongqing Medical University, Chongqing, 400016, China
| | - Yusi Liu
- Department of Laboratory Medicine, the First Affiliated Hospital of China Medical University, Shenyang, 110001, China
| | - Yibing Yin
- Department of Laboratory Medicine, Key Laboratory of Diagnostic Medicine (Ministry of Education), Chongqing Medical University, Chongqing, 400016, China
| | - Xuemei Zhang
- Department of Laboratory Medicine, Key Laboratory of Diagnostic Medicine (Ministry of Education), Chongqing Medical University, Chongqing, 400016, China.
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8
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Li X, Pan C, Liu Z, Sun P, Hua X, Feng E, Yu Y, Wu J, Zhu L, Wang H. Safety and immunogenicity of a new glycoengineered vaccine against Acinetobacter baumannii in mice. Microb Biotechnol 2021; 15:703-716. [PMID: 33755314 PMCID: PMC8867989 DOI: 10.1111/1751-7915.13770] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 01/27/2021] [Accepted: 01/28/2021] [Indexed: 12/03/2022] Open
Abstract
Acinetobacter baumannii poses a serious threat to human health, mainly because of its widespread distribution and severe drug resistance. However, no licensed vaccines exist for this pathogen. In this study, we created a conjugate vaccine against A. baumannii by introducing an O‐linked glycosylation system into the host strain. After demonstrating the ability of the vaccine to elicit Th1 and Th2 immune responses and observing its good safety in mouse a model, the strong in vitro bactericidal activity and prophylactic effects of the conjugate vaccine against infection were further demonstrated by evaluating post‐infection tissue bacterial loads, observing suppressed serum pro‐inflammatory cytokine levels. Additionally, the broad protection from the vaccine was further proved via lethal challenge with A. baumannii. Overall, these results indicated that the conjugate vaccine could elicit an efficient immune response and provide good protection against A. baumannii infection in murine sepsis models. Thus, the conjugate vaccine can be considered as a promising candidate vaccine for preventing A. baumannii infection.
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Affiliation(s)
- Xin Li
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Biotechnology, 20 Dongdajie Street, Fengtai District, Beijing, 100071, China
| | - Chao Pan
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Biotechnology, 20 Dongdajie Street, Fengtai District, Beijing, 100071, China
| | - Zhicheng Liu
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Biotechnology, 20 Dongdajie Street, Fengtai District, Beijing, 100071, China
| | - Peng Sun
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Biotechnology, 20 Dongdajie Street, Fengtai District, Beijing, 100071, China
| | - Xiaoting Hua
- Department of Infectious Diseases, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Erling Feng
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Biotechnology, 20 Dongdajie Street, Fengtai District, Beijing, 100071, China
| | - Yunsong Yu
- Department of Infectious Diseases, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Jun Wu
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Biotechnology, 20 Dongdajie Street, Fengtai District, Beijing, 100071, China
| | - Li Zhu
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Biotechnology, 20 Dongdajie Street, Fengtai District, Beijing, 100071, China
| | - Hengliang Wang
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Biotechnology, 20 Dongdajie Street, Fengtai District, Beijing, 100071, China
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9
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Cripps AW, Folaranmi T, Johnson KD, Musey L, Niederman MS, Buchwald UK. Immunogenicity following revaccination or sequential vaccination with 23-valent pneumococcal polysaccharide vaccine (PPSV23) in older adults and those at increased risk of pneumococcal disease: a review of the literature. Expert Rev Vaccines 2021; 20:257-267. [PMID: 33567914 DOI: 10.1080/14760584.2021.1889374] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Introduction: Immunogenicity studies evaluating sequential administration of pneumococcal conjugate vaccine (PCV) followed by 23-valent pneumococcal polysaccharide vaccine (PPSV23) or revaccination with PPSV23 have raised concerns that PPSV23 may not elicit higher antibody levels than those measured following PCV or first PPSV23 dose.Areas covered: Recent literature was evaluated for evidence of blunted immune response (hyporesponsiveness), focusing on studies using adequate intervals between doses in accordance with vaccination recommendations. In eight of nine studies that evaluated revaccination with PPSV23 at an interval of ≥5 years after the previous dose, immunoglobulin G geometric mean concentrations and/or opsonophagocytic assay geometric mean titers for most serotypes increased from pre- to post-repeat vaccination and were comparable between repeat and primary vaccination groups post-vaccination. In seven studies in which PPSV23 was administered after PCVs (8 weeks to 1 year apart), responses to PPSV23 were comparable to those seen after initial PCV dose for shared vaccine serotypes. Studies in which PCVs were administered after PPSV23 were not evaluated.Expert opinion: Published data suggest immune responses following repeat vaccination with PPSV23, or sequential PCV/PPSV23 vaccination, are robust, without evidence of hyporesponsiveness. PPSV23 vaccination of at-risk adults is essential to ensure broad protection against all 23 vaccine serotypes.
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Affiliation(s)
- Allan W Cripps
- Mucosal Immunology Research Group, Menzies Health Institute and School of Medicine, Griffith University, Gold Coast Campus, Southport QLD, Australia
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10
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Niederman MS, Folaranmi T, Buchwald UK, Musey L, Cripps AW, Johnson KD. Efficacy and effectiveness of a 23-valent polysaccharide vaccine against invasive and noninvasive pneumococcal disease and related outcomes: a review of available evidence. Expert Rev Vaccines 2021; 20:243-256. [PMID: 33478306 DOI: 10.1080/14760584.2021.1880328] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Introduction: Routine pneumococcal vaccination for adults aged ≥60 or ≥65 years and those with underlying at-risk and high-risk conditions is recommended in many countries. However, studies estimating the effectiveness of 23-valent pneumococcal polysaccharide vaccine (PPSV23) have revealed mixed results, partly due to variability in study design and endpoints used to assess outcomes.Areas covered: The authors conducted a literature review of independently randomized trials and real-world studies published from 2010 to 2020 that assessed the effectiveness and efficacy of PPSV23 against vaccine-type or any-serotype invasive and noninvasive pneumococcal disease in adults aged ≥60 years. The authors also evaluated differences in study design that may contribute to the heterogeneity of available evidence.Expert opinion: Policy decisions regarding the inclusion of vaccines into national immunization plans should consider study quality and limitations. This review shows that PPSV23 is effective against vaccine-type invasive pneumococcal disease and vaccine-type pneumococcal pneumonia and can lower the burden of vaccine-type pneumococcal pneumonia. PPSV23-conferred protection may be lower in adults aged ≥75 years, those with certain underlying conditions, and individuals who were vaccinated >5 years before disease onset. This is an important finding that supports the benefit of PPSV23 vaccination for older adults.
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Affiliation(s)
- Michael S Niederman
- Weill Cornell Medical College, Department of Pulmonary Critical Care Medicine, New York, NY, USA
| | | | | | | | - Allan W Cripps
- Menzies Health Institute Queensland and School of Medicine, Mucosal Immunology Research Group, Griffith University, Queensland, Australia
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11
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Affiliation(s)
- Kang Hao Cheong
- Science, Mathematics and Technology Cluster, Singapore University of Technology and Design, Singapore, S487372
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12
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Shoar S, Musher DM. Etiology of community-acquired pneumonia in adults: a systematic review. Pneumonia (Nathan) 2020; 12:11. [PMID: 33024653 PMCID: PMC7533148 DOI: 10.1186/s41479-020-00074-3] [Citation(s) in RCA: 81] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 08/25/2020] [Indexed: 01/25/2023] Open
Abstract
Background The etiology of community-acquired pneumonia (CAP) has evolved since the beginning of the antibiotic era. Recent guidelines encourage immediate empiric antibiotic treatment once a diagnosis of CAP is made. Concerns about treatment recommendations, on the one hand, and antibiotic stewardship, on the other, motivated this review of the medical literature on the etiology of CAP. Methods We conducted a systematic review of English-language literature on the etiology of CAP using methods defined by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched PubMed using a combination of the keywords ‘pneumonia’, ‘CAP’, ‘etiology’, ‘microbiology’, ‘bacteriology’, and ‘pathogen’. We examined articles on antibiotics that were develop to treat pneumonia. We reviewed all ‘related articles’ as well as studies referenced by those that came up in the search. After we excluded articles that did not give sufficient microbiological data or failed to meet other predetermined criteria, 146 studies remained. Data were stratified into diagnostic categories according to the microbiologic studies that were done; results are presented as the percentage in each category of all cases in which an etiology was established. Results Streptococcus pneumoniae remains the most common cause of CAP although declining in incidence; this decline has been greater in the US than elsewhere. Haemophilus influenzae is the second most common cause of CAP, followed by Staphylococcus aureus and Gram negative bacilli. The incidence of all bacteria as causes of CAP has declined because, with routine use of PCR for viruses, the denominator, cases with an established etiology, has increased. Viruses were reported on average in about 10% of cases, but recent PCR-based studies identified a respiratory virus in about 30% of cases of CAP, with substantial rates of viral/bacterial coinfection. Conclusion The results of this study justify current guidelines for initial empiric treatment of CAP. With pneumococcus and Haemophilus continuing to predominate, efforts at antibiotic stewardship might be enhanced by greater attention to the routine use of sputum Gram stain and culture. Because viral/bacterial coinfection is relatively common, the identification of a virus by PCR does not, by itself, allow for discontinuation of the antibiotic therapy.
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Affiliation(s)
- Saeed Shoar
- Medical Care Line (Infectious Disease Section), Michael E. DeBakey Veterans Affairs Medical Center, 2002 Holcombe Boulevard, Room 4B-370, Houston, TX 77030 USA
| | - Daniel M Musher
- Medical Care Line (Infectious Disease Section), Michael E. DeBakey Veterans Affairs Medical Center, 2002 Holcombe Boulevard, Room 4B-370, Houston, TX 77030 USA.,Department of Medicine, Baylor College of Medicine, Houston, TX 77030 USA
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13
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Root-Bernstein R. Possible Cross-Reactivity between SARS-CoV-2 Proteins, CRM197 and Proteins in Pneumococcal Vaccines May Protect Against Symptomatic SARS-CoV-2 Disease and Death. Vaccines (Basel) 2020; 8:E559. [PMID: 32987794 PMCID: PMC7712751 DOI: 10.3390/vaccines8040559] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 09/15/2020] [Accepted: 09/16/2020] [Indexed: 01/08/2023] Open
Abstract
Various studies indicate that vaccination, especially with pneumococcal vaccines, protects against symptomatic cases of SARS-CoV-2 infection and death. This paper explores the possibility that pneumococcal vaccines in particular, but perhaps other vaccines as well, contain antigens that might be cross-reactive with SARS-CoV-2 antigens. Comparison of the glycosylation structures of SARS-CoV-2 with the polysaccharide structures of pneumococcal vaccines yielded no obvious similarities. However, while pneumococcal vaccines are primarily composed of capsular polysaccharides, some are conjugated to cross-reacting material CRM197, a modified diphtheria toxin, and all contain about three percent protein contaminants, including the pneumococcal surface proteins PsaA, PspA and probably PspC. All of these proteins have very high degrees of similarity, using very stringent criteria, with several SARS-CoV-2 proteins including the spike protein, membrane protein and replicase 1a. CRM197 is also present in Haemophilus influenzae type b (Hib) and meningitis vaccines. Equivalent similarities were found at lower rates, or were completely absent, among the proteins in diphtheria, tetanus, pertussis, measles, mumps, rubella, and poliovirus vaccines. Notably, PspA and PspC are highly antigenic and new pneumococcal vaccines based on them are currently in human clinical trials so that their effectiveness against SARS-CoV-2 disease is easily testable.
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14
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Root-Bernstein R. Age and Location in Severity of COVID-19 Pathology: Do Lactoferrin and Pneumococcal Vaccination Explain Low Infant Mortality and Regional Differences? Bioessays 2020; 42:e2000076. [PMID: 32869330 DOI: 10.1002/bies.202000076] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 07/17/2020] [Indexed: 12/21/2022]
Abstract
Two conundrums puzzle COVID-19 investigators: 1) morbidity and mortality is rare among infants and young children and 2) rates of morbidity and mortality exhibit large variances across nations, locales, and even within cities. It is found that the higher the rate of pneumococcal vaccination in a nation (or city) the lower the COVID-19 morbidity and mortality. Vaccination rates with Bacillus Calmette-Guerin, poliovirus, and other vaccines do not correlate with COVID-19 risks, nor do COVID-19 case or death rates correlate with number of people in the population with diabetes, obesity, or adults over 65. Infant protection may be due to maternal antibodies and antiviral proteins in milk such as lactoferrin that are known to protect against coronavirus infections. Subsequent protection might then be conferred (and correlate with) rates of Haemophilus influenzae type B (Hib) (universal in infants) and pneumococcal vaccination, the latter varying widely by geography among infants, at-risk adults, and the elderly. Also see the video abstract here https://youtu.be/GODBYRbPL00.
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15
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Vacunas en salud laboral… una oportunidad para prevenir e invertir en salud. REVISTA MÉDICA CLÍNICA LAS CONDES 2020. [DOI: 10.1016/j.rmclc.2020.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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16
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Müller A, Salmen A, Aebi S, de Gouveia L, von Gottberg A, Hathaway LJ. Pneumococcal serotype determines growth and capsule size in human cerebrospinal fluid. BMC Microbiol 2020; 20:16. [PMID: 31959125 PMCID: PMC6971925 DOI: 10.1186/s12866-020-1700-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Accepted: 01/09/2020] [Indexed: 12/02/2022] Open
Abstract
Background The polysaccharide capsule is a major virulence factor of S. pneumoniae in diseases such as meningitis. While some capsular serotypes are more often found in invasive disease, high case fatality rates are associated with those serotypes more commonly found in asymptomatic colonization. We tested whether growth patterns and capsule size in human cerebrospinal fluid depends on serotype using a clinical isolate of S. pneumoniae and its capsule switch mutants. Results We found that the growth pattern differed markedly from that in culture medium by lacking the exponential and lysis phases. Growth in human cerebrospinal fluid was reduced when strains lost their capsules. When a capsule was present, growth was serotype-specific: high carriage serotypes (6B, 9 V, 19F and 23F) grew better than low carriage serotypes (7F, 14, 15B/C and 18C). Growth correlated with the case-fatality rates of serotypes reported in the literature. Capsule size in human cerebrospinal fluid also depended on serotype. Conclusions We propose that serotype-specific differences in disease severity observed in meningitis patients may, at least in part, be explained by differences in growth and capsule size in human cerebrospinal fluid. This information could be useful to guide future vaccine design.
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Affiliation(s)
- Annelies Müller
- Institute for Infectious Diseases, Faculty of Medicine, University of Bern, Friedbühlstrasse 51, CH-3001, Bern, Switzerland.,Graduate School for Cellular and Biomedical Sciences, University of Bern, Bern, Switzerland
| | - Anke Salmen
- Department of Neurology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
| | - Suzanne Aebi
- Institute for Infectious Diseases, Faculty of Medicine, University of Bern, Friedbühlstrasse 51, CH-3001, Bern, Switzerland
| | - Linda de Gouveia
- National Institute for Communicable Diseases: Division of the National Health Laboratory Service, Johannesburg, South Africa
| | - Anne von Gottberg
- National Institute for Communicable Diseases: Division of the National Health Laboratory Service, Johannesburg, South Africa.,Faculty of Health Sciences, School of Pathology, University of Witwatersrand, Johannesburg, South Africa
| | - Lucy J Hathaway
- Institute for Infectious Diseases, Faculty of Medicine, University of Bern, Friedbühlstrasse 51, CH-3001, Bern, Switzerland.
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17
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Rondaan C, Furer V, Heijstek MW, Agmon-Levin N, Bijl M, Breedveld FC, D'Amelio R, Dougados M, Kapetanovic MC, van Laar JM, Ladefoged de Thurah A, Landewé R, Molto A, Müller-Ladner U, Schreiber K, Smolar L, Walker J, Warnatz K, Wulffraat NM, van Assen S, Elkayam O. Efficacy, immunogenicity and safety of vaccination in adult patients with autoimmune inflammatory rheumatic diseases: a systematic literature review for the 2019 update of EULAR recommendations. RMD Open 2019; 5:e001035. [PMID: 31565247 PMCID: PMC6744079 DOI: 10.1136/rmdopen-2019-001035] [Citation(s) in RCA: 86] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 08/01/2019] [Accepted: 08/06/2019] [Indexed: 12/18/2022] Open
Abstract
Aim To present a systematic literature review (SLR) on efficacy, immunogenicity and safety of vaccination in adult patients with autoimmune inflammatory rheumatic diseases (AIIRD), aiming to provide a basis for updating the EULAR evidence-based recommendations. Methods An SLR was performed according to the standard operating procedures for EULAR-endorsed recommendations. Outcome was determined by efficacy, immunogenicity and safety of vaccination in adult patients with AIIRD, including those receiving immunomodulating therapy. Furthermore, a search was performed on the effect of vaccinating household members of patients with AIIRD on the occurrence of vaccine-preventable infections in patients and their household members (including newborns). The literature search was performed using Medline, Embase and the Cochrane Library (October 2009 to August 2018). Results While most investigated vaccines were efficacious and/or immunogenic in patients with AIIRD, some were less efficacious than in healthy control subjects, and/or in patients receiving immunosuppressive agents. Adverse events of vaccination were generally mild and the rates were comparable to those in healthy persons. Vaccination did not seem to lead to an increase in activity of the underlying AIIRD, but insufficient power of most studies precluded arriving at definite conclusions. The number of studies investigating clinical efficacy of vaccination is still limited. No studies on the effect of vaccinating household members of patients with AIIRD were retrieved. Conclusion Evidence on efficacy, immunogenicity and safety of vaccination in patients with AIIRD was systematically reviewed to provide a basis for updated recommendations.
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Affiliation(s)
- Christien Rondaan
- Medical microbiology and infection prevention, UMCG, Groningen, The Netherlands.,Rheumatology and Clinical Immunology, UMCG, Groningen, The Netherlands
| | - Victoria Furer
- Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Faculty of Medicine, Tel Aviv University Sackler, Tel Aviv, Israel
| | - Marloes W Heijstek
- Internal Medicine and Allergology, Rheumatology and Clinical Immunology, UMC Utrecht, Utrecht, The Netherlands
| | - Nancy Agmon-Levin
- Faculty of Medicine, Tel Aviv University Sackler, Tel Aviv, Israel.,Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Israel
| | - Marc Bijl
- Internal Medicine, Martini Hospital, Groningen, The Netherlands
| | - Ferdinand C Breedveld
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Raffaele D'Amelio
- Dipartimento di Medicina Clinica e Molecolare, Sapienza University of Rome, Roma, Italy
| | - Maxime Dougados
- Hopital Cochin, Rheumatology, Université Paris Descartes, Paris, France.,Clinical epidemiology and biostatistics, PRES Sorbonne Paris- Cité, Paris, France
| | - Meliha C Kapetanovic
- Department of Clinical Sciences, Section for Rheumatology, Lund University, Lund and Skåne University Hospital, Lund, Sweden
| | - Jacob M van Laar
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Robert Landewé
- Clinical Immunology & Rheumatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,Rheumatology, Zuyderland Medical Centre, Sittard-Geleen - Heerlen, The Netherlands
| | - Anna Molto
- Hopital Cochin, Rheumatology, Université Paris Descartes, Paris, France
| | - Ulf Müller-Ladner
- Rheumatology and Clinical Immunology, Giessen University, Giessen, Germany
| | - Karen Schreiber
- Department of Thrombosis and Haemophilia, Guy's and Saint Thomas' Hospitals NHS Trust, London, UK.,Rheumatology, King Christian X's Hospital for Rheumatic Diseases in Gråsten, Graasten, Denmark
| | - Leo Smolar
- Patient Research Partner, Tel Aviv, Israel
| | - Jim Walker
- Patient Research Partner, Elgin, Scotland
| | - Klaus Warnatz
- Centre for Chronic Immunodeficiency, University Medical Centre Freiburg, Freiburg, Germany
| | - Nico M Wulffraat
- Pediatric Rheumatology, Wilhelmina Kinderziekenhuis, Utrecht, The Netherlands
| | - Sander van Assen
- Internal medicine (infectious diseases), Treant Care Group, Hoogeveen, The Netherlands
| | - Ori Elkayam
- Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Faculty of Medicine, Tel Aviv University Sackler, Tel Aviv, Israel
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18
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van der Linden M, Imöhl M, Perniciaro S. Limited indirect effects of an infant pneumococcal vaccination program in an aging population. PLoS One 2019; 14:e0220453. [PMID: 31369597 PMCID: PMC6675109 DOI: 10.1371/journal.pone.0220453] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 07/16/2019] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND A general recommendation for adult pneumococcal vaccination with 23-valent polysaccharide vaccine (PPV23) for adults 60 and older has been in place in Germany since 1998, but uptake has been low. Just over a decade after the implementation of an infant pneumococcal conjugate vaccine recommendation, we examined indirect protection effects on adult invasive pneumococcal disease (IPD) in Germany. METHODS AND FINDINGS Reported IPD cases decreased in children under two years of age from 11.09 per 100,000 in 2003-2006 to 5.94 per 100,000 in 2017/18, while in adult age groups, reported IPD cases rose across the board, most dramatically in adults 60 years of age and over, from 1.64 to 10.08 cases per 100,000. PCV13-type IPD represents 31% of all cases in this age group, the lion's share of which is due to the rapid increase of serotype 3 IPD, which, by itself, has reached 2.11 reported cases per 100,000 and makes up 21% of all IPD cases in this age group. The two vaccine formulations currently in development (PCV15 and PCV20) would increase current (PCV13) coverage by 8.5% points and 28.0% points in children, while in adults coverage would increase by 10.4% points and 21.9% points, respectively. CONCLUSIONS While original models predicted that indirect effects of childhood vaccination would suffice for adults, it seems that the herd protection effect has reached its limit, with vaccine serotypes 4, 19F, and 19A IPD persisting in adults after initial reductions, and serotype 3 IPD not showing any herd protection effect at all.
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Affiliation(s)
- Mark van der Linden
- National Reference Center for Streptococci, Department of Medical Microbiology, University Hospital (RWTH), Aachen, Germany
| | - Matthias Imöhl
- National Reference Center for Streptococci, Department of Medical Microbiology, University Hospital (RWTH), Aachen, Germany
| | - Stephanie Perniciaro
- National Reference Center for Streptococci, Department of Medical Microbiology, University Hospital (RWTH), Aachen, Germany
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19
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Vila-Córcoles A, Ochoa-Gondar O, de Diego C, Satué E, Vila-Rovira A, Aragón M. Pneumococcal vaccination coverages by age, sex and specific underlying risk conditions among middle-aged and older adults in Catalonia, Spain, 2017. Euro Surveill 2019; 24:1800446. [PMID: 31339099 PMCID: PMC6652112 DOI: 10.2807/1560-7917.es.2019.24.29.1800446] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 04/25/2019] [Indexed: 11/20/2022] Open
Abstract
BackgroundRecent published data on pneumococcal vaccination coverages among adults are scarce.AimTo update on pneumococcal vaccination uptakes among middle-aged and older adults in Catalonia.MethodsWe conducted a population-based retrospective observational study including 2,057,656 individuals ≥ 50 years old assigned to primary care centres managed by the Catalonian Health Institute on 1 January 2017 (date of data collection). An institutional clinical research database (SIDIAP) was used to classify persons by vaccination status for both 23-valent pneumococcal polysaccharide (PPsV23) and 13-valent pneumococcal conjugate (PCV13) vaccines, as well as to identify underlying risk conditions.ResultsOverall, 796,879 individuals (38.7%) had received PPsV23 and 13,607 (0.7%) PCV13. PPsV23 coverage increased with age: 9.2% (95,409/1,039,872) in 50-64 year olds, 63.1% (434,408/688,786) in 65-79 year olds and 81.2% (267,062/328,998) in ≥ 80 year olds (p < 0.001). PCV13 coverage also increased with age, although percentages were smaller in all age strata (4,250/1,039,872: 0.4%; 6,005/688,786: 0.9% and 3,352/328,998: 1.0%, respectively; p < 0.001). By sex, no substantial coverage differences were observed. Considering publically funded target groups for PPsV23 vaccination in Catalonia (i.e. < 65 year olds with at least one risk factor, plus all adults aged ≥ 65 years), PPsV23 coverage reached 52.8% (771,722/1,462,261) in our study population. Regarding PCV13 publicly funded targets (i.e. all-age immunocompromised persons), PCV13 coverage was 3.3% (6,617/202,348). By risk conditions, the highest PPsV23 coverage appeared in congestive heart failure (51,909/63,596; 81.6%), chronic renal disease (122,791/158,726; 77.4%) and chronic bronchitis/emphysema (96,453/132,306; 72.9%). Maximum PCV13 coverage appeared in cirrhosis (294/7,957; 3.7%), chronic renal disease (5,633/158,726; 3.5%) and chronic bronchitis/emphysema (2,859/132,306; 2.2%).ConclusionPneumococcal vaccination coverages in Catalonian adults are suboptimal, especially for PCV13.
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Affiliation(s)
- Angel Vila-Córcoles
- Primary Health Care Service Camp de Tarragona, Tarragona, Spain
- Unitat de Suport a la Recerca of Tarragona, Institut Universitari d'Investigacio en Atencio Primaria Jordi Gol (IDIAP Jordi Gol), Tarragona, Spain
| | - Olga Ochoa-Gondar
- Primary Health Care Service Camp de Tarragona, Tarragona, Spain
- Unitat de Suport a la Recerca of Tarragona, Institut Universitari d'Investigacio en Atencio Primaria Jordi Gol (IDIAP Jordi Gol), Tarragona, Spain
| | - Cinta de Diego
- Primary Health Care Service Camp de Tarragona, Tarragona, Spain
| | - Eva Satué
- Primary Health Care Service Camp de Tarragona, Tarragona, Spain
- Unitat de Suport a la Recerca of Tarragona, Institut Universitari d'Investigacio en Atencio Primaria Jordi Gol (IDIAP Jordi Gol), Tarragona, Spain
| | | | - Maria Aragón
- Information System for the Improvement of Research in Primary Care (SIDIAP), Primary Care Research Institute Jordi Gol, Universitat Autonoma de Barcelona, Barcelona, Spain
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20
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Jiang Y, Zhang X, Lv Q, Qi J, Guo X, Wei Q, Liao Z, Lin Z, Gu J. Knowledge, attitude, and practice regarding infection and vaccination in patients with rheumatic diseases in China. Hum Vaccin Immunother 2019; 15:1100-1105. [PMID: 30689509 DOI: 10.1080/21645515.2019.1568160] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Objective Vaccines including pneumococcal and influenza vaccines are recommended in patients with immunosuppressive treatment. However, vaccine coverage remains extremely low. Our study was to investigate vaccination uptake, knowledge, attitude and practice (KAP) towards certain vaccinations among these patients, and to identify the factors influencing willingness to be vaccinated. Methods A cross-sectional survey was conducted among patients with rheumatic diseases in a tertiary hospital in China. Baseline assessments were completed by using questionnaires including vaccination uptake and KAP towards certain infections and vaccinations. Results 235 patients completed the study. Mean age was 39.69 years old, while 66.4% were females. Only 6.4% of the participants once had taken vaccine in recent five years. One patient had influenza vaccination, and none ever took pneumococcal vaccine. 3.8% had doctor's recommendation on taking influenza, pneumococcal or herpes zoster vaccine. Major reasons given for not being vaccinated included "unnecessary" (8.9%) and "troublesome to take vaccines" (8.5%). Patients would take influenza or pneumococcal vaccines if they had heard of them before, had knowledge of infection, and had belief in vaccine's safety and reliability (p < 0.05). Conclusion Vaccine coverage among people with rheumatic diseases was low in China. Methods to improve KAP toward infections and vaccinations should be taken.
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Affiliation(s)
- Yutong Jiang
- a Department of Rheumatology , the Third Affiliated Hospital of Sun Yat-sen University , Guangzhou , China
| | - Xi Zhang
- a Department of Rheumatology , the Third Affiliated Hospital of Sun Yat-sen University , Guangzhou , China
| | - Qing Lv
- a Department of Rheumatology , the Third Affiliated Hospital of Sun Yat-sen University , Guangzhou , China
| | - Jun Qi
- a Department of Rheumatology , the Third Affiliated Hospital of Sun Yat-sen University , Guangzhou , China
| | - Xinghua Guo
- a Department of Rheumatology , the Third Affiliated Hospital of Sun Yat-sen University , Guangzhou , China
| | - Qiujing Wei
- a Department of Rheumatology , the Third Affiliated Hospital of Sun Yat-sen University , Guangzhou , China
| | - Zetao Liao
- a Department of Rheumatology , the Third Affiliated Hospital of Sun Yat-sen University , Guangzhou , China
| | - Zhiming Lin
- a Department of Rheumatology , the Third Affiliated Hospital of Sun Yat-sen University , Guangzhou , China
| | - Jieruo Gu
- a Department of Rheumatology , the Third Affiliated Hospital of Sun Yat-sen University , Guangzhou , China
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21
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Stacey HL, Rosen J, Peterson JT, Williams-Diaz A, Gakhar V, Sterling TM, Acosta CJ, Nolan KM, Li J, Pedley A, Benner P, Abeygunawardana C, Kosinski M, Smith WJ, Pujar H, Musey LK. Safety and immunogenicity of 15-valent pneumococcal conjugate vaccine (PCV-15) compared to PCV-13 in healthy older adults. Hum Vaccin Immunother 2019; 15:530-539. [PMID: 30648919 DOI: 10.1080/21645515.2018.1532249] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Pneumococcal disease remains a public health priority in adults. Safety and immunogenicity of 2 different formulations of 15-valent pneumococcal conjugate vaccine (PCV15) containing 13 serotypes included in 13-valent pneumococcal conjugate vaccine (PCV13) plus 2 additional serotypes (22F and 33F) were evaluated in adults ≥ 50 years (V114-006; NCT02547649). METHODS A total of 690 subjects (230/arm) received a single dose of either PCV15 Formulation A, PCV15 Formulation B, or PCV13 and were followed for safety for 14 days postvaccination. Serotype-specific opsonophagocytic activity (OPA) geometric mean titers (GMTs) and Immunoglobulin G (IgG) geometric mean concentrations (GMCs) were measured immediately prior and 30 days postvaccination. RESULTS Both PCV15 formulations had generally comparable safety profiles to PCV13. Baseline IgG GMCs and OPA GMTs were comparable across vaccination groups. At 30 days postvaccination, both PCV15 formulations induced serotype specific antibodies to all 15 serotypes in the vaccine. IgG GMCs and OPA GMTs in recipients of either PCV15 formulation were non-inferior (≤ 2-fold margin) to those measured in recipients of PCV13 for shared serotypes and superior (> 1.0-fold difference) for serotypes unique to PCV15. Formulation B generally induced higher immune responses than Formulation A. CONCLUSION In healthy adults ≥ 50 years of age, both new formulations of PCV15 displayed acceptable safety profiles and induced serotype-specific immune responses comparable to PCV13.
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Affiliation(s)
- Helen L Stacey
- a Diablo Clinical Research, Inc , Walnut Creek , CA , USA
| | - Jeffrey Rosen
- b Clinical Research of South Florida , Coral Gables , FL , USA
| | - James T Peterson
- c J. Lewis Research, Inc./Foothill Family Clinic , Salt Lake City , USA
| | | | - Vanita Gakhar
- d Merck & Co., Inc., Merck Research Laboratories , Kenilworth , NJ , USA
| | - Tina M Sterling
- d Merck & Co., Inc., Merck Research Laboratories , Kenilworth , NJ , USA
| | - Camilo J Acosta
- d Merck & Co., Inc., Merck Research Laboratories , Kenilworth , NJ , USA
| | - Katrina M Nolan
- d Merck & Co., Inc., Merck Research Laboratories , Kenilworth , NJ , USA
| | - Jianing Li
- d Merck & Co., Inc., Merck Research Laboratories , Kenilworth , NJ , USA
| | - Alison Pedley
- d Merck & Co., Inc., Merck Research Laboratories , Kenilworth , NJ , USA
| | - Patrice Benner
- d Merck & Co., Inc., Merck Research Laboratories , Kenilworth , NJ , USA
| | | | - Michael Kosinski
- d Merck & Co., Inc., Merck Research Laboratories , Kenilworth , NJ , USA
| | - William J Smith
- d Merck & Co., Inc., Merck Research Laboratories , Kenilworth , NJ , USA
| | - Hari Pujar
- d Merck & Co., Inc., Merck Research Laboratories , Kenilworth , NJ , USA
| | - Luwy K Musey
- d Merck & Co., Inc., Merck Research Laboratories , Kenilworth , NJ , USA
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22
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Horácio AN, Silva-Costa C, Lopes E, Ramirez M, Melo-Cristino J. Conjugate vaccine serotypes persist as major causes of non-invasive pneumococcal pneumonia in Portugal despite declines in serotypes 3 and 19A (2012-2015). PLoS One 2018; 13:e0206912. [PMID: 30388168 PMCID: PMC6214563 DOI: 10.1371/journal.pone.0206912] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 10/22/2018] [Indexed: 11/30/2022] Open
Abstract
Non-invasive pneumococcal pneumonia (NIPP) is a frequent cause of morbidity and mortality worldwide. The 13-valent pneumococcal conjugate vaccine (PCV13) was included in the national immunization program of children living in Portugal in 2015. Until then, PCV7 (since late 2001) and PCV13 (since early 2010) were given through the private market. We determined the serotype distribution and antimicrobial susceptibility of isolates causing adult NIPP in 2012–2015 and compared the results with previously published data (2007–2011). There were 50 serotypes among the 1435 isolates. The most common were serotypes: 3 (14%), 11A (8%), 19F (6%), 23A (5%), 6C (5%), 19A (4%), 23B (4%), 9N (4%) and non-typable isolates (4%). When considering data since the availability of PCV13 for children in the private market, the proportion of PCV13 serotypes declined from 44.0% in 2010 to 29.7% in 2015 (p < 0.001), mainly due to early decreases in the proportions of serotypes 3 and 19A. In contrast, during the same period, PCV7 serotypes (11.9% in 2012–2015) and the serotypes exclusive of the 23-valent polysaccharide vaccine (26.0% in 2012–2015), remained relatively stable, while non-vaccine types increased from 27.0% in 2010 to 41.9% in 2015 (p<0.001). According to the Clinical and Laboratory Standards Institute (CLSI) breakpoints, penicillin non-susceptible and erythromycin resistant isolates accounted for 1% and 21.7%, respectively, of the isolates recovered in 2012–2015, with no significant changes seen since 2007. Comparison of NIPP serotypes with contemporary invasive disease serotypes identified associations of 19 serotypes with either disease presentation. The introduction of PCV13 in the national immunization program for children from 2015 onwards may lead to reductions in the proportion of NIPP due to vaccine serotypes but continued NIPP surveillance is essential due to a different serotype distribution from invasive disease.
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Affiliation(s)
- Andreia N. Horácio
- Instituto de Microbiologia, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Catarina Silva-Costa
- Instituto de Microbiologia, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Elísia Lopes
- Instituto de Microbiologia, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Mário Ramirez
- Instituto de Microbiologia, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
- * E-mail:
| | - José Melo-Cristino
- Instituto de Microbiologia, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
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23
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Parker S, Hoosen AA, Feldman C, Gamil A, Naidoo J, Khan S. Respiratory infections due to Streptococcus pneumoniae and the influenza virus in South Africans undertaking the Hajj. S Afr J Infect Dis 2018. [DOI: 10.1080/23120053.2018.1484591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
| | - Anwar Ahmed Hoosen
- Department of Medical Microbiology, University of the Free State, Bloemfontein, South Africa
- Microbiology Laboratory, Universitas Academic Laboratory, National Health Laboratory Service, Bloemfontein, South Africa
| | - Charles Feldman
- Division of Pulmonology, Department of Internal Medicine, Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Amgad Gamil
- Pfizer Global Medical Development and Scientific/Clinical Affairs, Vaccines, Pfizer Inc, Dubai, UAE
| | - Jerusha Naidoo
- Pfizer Global Medical Development and Scientific/Clinical Affairs, Vaccines, Pfizer Inc, Johannesburg, South Africa
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Yin M, Huang L, Zhang Y, Yu N, Xu X, Liang Y, Ni J. Effectiveness and safety of dual influenza and pneumococcal vaccination versus separate administration or no vaccination in older adults: a meta-analysis. Expert Rev Vaccines 2018; 17:653-663. [PMID: 29961353 DOI: 10.1080/14760584.2018.1495077] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Mingjuan Yin
- Department of Epidemiology and Biostatistics, Guangdong Medical University, Dongguan, China
| | - Lingfeng Huang
- Department of Epidemiology and Biostatistics, Guangdong Medical University, Dongguan, China
| | - Yan Zhang
- Department of Epidemiology and Biostatistics, Guangdong Medical University, Dongguan, China
| | - Na Yu
- Office of Research and Teaching, The Third Affiliated Hospital of GuangDong Medical University (LongJiang Hospital of Shunde District Fo Shan City), Fo Shan, China
| | - Xiaojia Xu
- Department of Epidemiology and Biostatistics, Guangdong Medical University, Dongguan, China
| | - Yaping Liang
- Department of Epidemiology and Biostatistics, Guangdong Medical University, Dongguan, China
| | - Jindong Ni
- Department of Epidemiology and Biostatistics, Guangdong Medical University, Dongguan, China
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25
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Immunogenicity and safety of the adjuvanted recombinant zoster vaccine co-administered with the 23-valent pneumococcal polysaccharide vaccine in adults ≥50 years of age: A randomized trial. Vaccine 2018; 36:4278-4286. [DOI: 10.1016/j.vaccine.2018.05.110] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 05/25/2018] [Accepted: 05/29/2018] [Indexed: 11/18/2022]
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26
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Rijkers GT, Yousif LI, Spoorenberg SM, van Overveld FJ. Triptych of the Hermit Saints: pneumococcal polysaccharide vaccines for the elderly. Risk Manag Healthc Policy 2018; 11:55-65. [PMID: 29636634 PMCID: PMC5881283 DOI: 10.2147/rmhp.s130405] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Pneumococcal pneumonia is a serious disease with considerable morbidity and mortality in the elderly. Despite adequate antibiotic treatment, the long-term mortality of pneumococcal pneumonia remains high. Preventive measures in the form of vaccination, therefore, are warranted. Twenty-three-valent polysaccharide vaccines have a broad coverage but limited efficacy. Pneumococcal conjugate vaccines have been shown in children to be able to prevent invasive and mucosal pneumococcal diseases. It should be realized that the serotype composition of current pneumococcal conjugate vaccines is not tailored for the elderly, and that replacement disease can occur. Yet, the current 13-valent conjugate vaccine has been shown to protect against infections with vaccine serotypes. Long-term mortality of pneumococcal pneumonia should be included in policy making about the introduction of these vaccines for the elderly.
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Affiliation(s)
- Ger T Rijkers
- Department of Science, University College Roosevelt, Middelburg, the Netherlands.,Department of Medical Microbiology and Immunology, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Laura Ie Yousif
- Department of Science, University College Roosevelt, Middelburg, the Netherlands
| | | | - Frans J van Overveld
- Department of Science, University College Roosevelt, Middelburg, the Netherlands
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27
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Ermlich SJ, Andrews CP, Folkerth S, Rupp R, Greenberg D, McFetridge RD, Hartzel J, Marchese RD, Stek JE, Abeygunawardana C, Musey LK. Safety and immunogenicity of 15-valent pneumococcal conjugate vaccine in pneumococcal vaccine-naïve adults ≥50 years of age. Vaccine 2018; 36:6875-6882. [PMID: 29559167 DOI: 10.1016/j.vaccine.2018.03.012] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 02/07/2018] [Accepted: 03/05/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Pneumococcal disease remains a public health priority in adults. Safety and immunogenicity of 15-valent pneumococcal conjugate vaccine (PCV15) containing 13 serotypes included in 13-valent pneumococcal conjugate vaccine (PCV13) plus 2 additional serotypes (22F and 33F) was evaluated in adults ≥50 years old (NCT01513551). METHODS 691 adults received one dose of PCV15, PCV13, or 23-valent pneumococcal polysaccharide vaccine (PPV23) and were followed 14 days for safety. Serotype-specific IgG geometric mean concentrations (GMCs) and opsonophagocytic activity (OPA) geometric mean titers (GMTs) were measured immediately prior and 1-month postvaccination. RESULTS Safety profiles were comparable across vaccination groups. PCV15 induced comparable levels of IgG GMCs and OPA GMTs to PCV13 and PPV23 for shared serotypes. Serotype-specific antibodies were numerically higher among recipients of PCV15 than PCV13 and PPV23 for 7 and 12 shared serotypes, respectively; and lower for 4 and 1 serotype(s), respectively. PCV15 induced higher IgG and OPA antibodies than PCV13 or PPV23 for serotypes unique to PCV15 (22F and 33F not in PCV13; 6A not in PPV23). CONCLUSIONS PCV15 displayed an acceptable safety profile and induced IgG and OPA to all 15 serotypes included in the vaccine, at levels comparable to PCV13 and PPV23 for shared serotypes with these vaccines. Study identification: V114-002. CLINICALTRIALS.GOV identifier: NCT01513551. © 2018 Merck & Co., Inc.
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Affiliation(s)
| | | | | | - Richard Rupp
- University of Texas Medical Branch at Galveston, Galveston, TX, USA
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28
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Wang Y, Li J, Wang Y, Gu W, Zhu F. Effectiveness and practical uses of 23-valent pneumococcal polysaccharide vaccine in healthy and special populations. Hum Vaccin Immunother 2017; 14:1003-1012. [PMID: 29261406 PMCID: PMC5893217 DOI: 10.1080/21645515.2017.1409316] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Streptococcus pneumonia (S. pneumoniae) is responsible for significant morbidity and mortality throughout the world. The 23-valent pneumococcal polysaccharide vaccines (PPV23) have been widely used for many years, but challenges are remaining in some respects, especially for its effectiveness among high-risk populations and older adults. This review aims to summarize recent clinical trials and studies of PPV23 vaccination among healthy people ≥ 2 years of age and those with high-risk conditions such as pregnant women, individuals with immunocompromising diseases and other chronic conditions, and provide health officials in China and other developing countries a comprehensive understanding of the current vaccination strategies for PPV23 and for the combined use of PPV23 and pneumococcal conjugate vaccines (PCVs) in adults.
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Affiliation(s)
- Yang Wang
- a School of Public Health, Southeast University , Nanjing , PR China
| | - Jingxin Li
- b Jiangsu Provincial Center for Disease Control and Prevention , Nanjing , PR China
| | - Yuxiao Wang
- a School of Public Health, Southeast University , Nanjing , PR China
| | - Wei Gu
- c School of Public Health, Nanjing Medical University , Nanjing , PR China
| | - Fengcai Zhu
- b Jiangsu Provincial Center for Disease Control and Prevention , Nanjing , PR China
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29
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Singer J, Testori C, Schellongowski P, Handisurya A, Müller C, Reitter EM, Graninger W, Knöbl P, Staudinger T, Winkler S, Thalhammer F. A case report of septic shock syndrome caused by S. pneumoniae in an immunocompromised patient despite of vaccination. BMC Infect Dis 2017; 17:442. [PMID: 28641577 PMCID: PMC5480414 DOI: 10.1186/s12879-017-2481-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 05/22/2017] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND AND CASE PRESENTATION We report a case of septic shock syndrome caused by Streptococcus pneumoniae in a patient who had undergone splenectomy due to an autoimmune lymphoproliferative syndrome (ALPS), which is characterized as a dysfunction of immunoregulation. Although the patient was vaccinated with a conjugated polysaccharide vaccine after the splenectomy, he was still susceptible to S. pneumoniae infection, because the isolated serovar (24F), a serovar long thought to be apathogenic, is not covered by any vaccine currently approved, neither a conjugated nor an unconjugated polysaccharide one. CONCLUSIONS This case demonstrates that, due to presence of different serovars, also infections with bacteria against which patients are vaccinated have to be considered as differential diagnosis. Although vaccine development has extended the coverage of S. pneumoniae from 7 to 23 serovars within recent years, there is still demand for novel vaccines which can provide broader protection also against so-thought "apathogenic" strains, especially for groups at high risk.
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Affiliation(s)
- Josef Singer
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine I, Medical University of Vienna, 1090 Vienna, Austria
| | - Christoph Testori
- Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna, Austria
| | - Peter Schellongowski
- Intensive Care Unit 13i2, Department of Internal Medicine I, Medical University of Vienna, 1090 Vienna, Austria
| | - Ammon Handisurya
- Clinical Department for Nephrology and Dialysis, Department of Internal Medicine III, Medical University of Vienna, 1090 Vienna, Austria
| | - Catharina Müller
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine I, Medical University of Vienna, 1090 Vienna, Austria
| | - Eva-Maria Reitter
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine I, Medical University of Vienna, 1090 Vienna, Austria
| | - Wolfgang Graninger
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine I, Medical University of Vienna, 1090 Vienna, Austria
| | - Paul Knöbl
- Clinical Department of Hematology and Hemostaseology, Department of Internal Medicine I, Medical University of Vienna, 1090 Vienna, Austria
| | - Thomas Staudinger
- Intensive Care Unit 13i2, Department of Internal Medicine I, Medical University of Vienna, 1090 Vienna, Austria
| | - Stefan Winkler
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine I, Medical University of Vienna, 1090 Vienna, Austria
| | - Florian Thalhammer
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine I, Medical University of Vienna, 1090 Vienna, Austria
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30
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Su Y, Li D, Xing Y, Wang H, Wang J, Yuan J, Wang X, Cui F, Yin Y, Zhang X. Subcutaneous Immunization with Fusion Protein DnaJ-ΔA146Ply without Additional Adjuvants Induces both Humoral and Cellular Immunity against Pneumococcal Infection Partially Depending on TLR4. Front Immunol 2017; 8:686. [PMID: 28659923 PMCID: PMC5466963 DOI: 10.3389/fimmu.2017.00686] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 05/26/2017] [Indexed: 01/13/2023] Open
Abstract
Subunit vaccines that are poorly immunogenic are often combined with adjuvants for immunization. Our previous research identified a pneumolysin variant (ΔA146Ply), a Toll-like receptor 4 agonist, that was an effective adjuvant in the protection of fusion protein DnaJ-ΔA146Ply against mucosal Streptococcus pneumoniae infections. For pneumococcal vaccines, World Health Organization recommend injection as a regular vaccination approach. Subcutaneous immunization is a common and effective method of injection, so we explored the immunity mechanism of subcutaneous immunization with DnaJ-ΔA146Ply. We found that mice immunized subcutaneously with fusion proteins ΔA146Ply-DnaJ and DnaJ-ΔA146Ply produced a higher anti-DnaJ IgG titer than when DnaJ alone was administered. DnaJ-ΔA146Ply induced both B-cell and T-cell-dependent protection against both colonization and lethal pneumococcal infections. Levels of IFN-γ, IL-4, and IL-17A were also elevated in DnaJ-ΔA146Ply immunized mice. However, all these effects were negated in TLR4-/- mice compared to WT mice immunized with DnaJ-ΔA146Ply. B-cell-deficient μMT mice, nude mice, IFN-γ-/-, and IL-4-/- mice immunized with DnaJ-ΔA146Ply could not resist infection with pneumococci. IL-17A-/- and TLR4-/- mice did not benefit from DnaJ-ΔPly immunization in colonization experiments although their survival was not impaired compared with WT mice. Collectively, our data indicated that ΔA146Ply can be a potential subcutaneous adjuvant, and the DnaJ-ΔA146Ply fusion protein induces both humoral and cellular immune response to resist S. pneumoniae infection. The protective effect of colonization also depends on TLR4.
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Affiliation(s)
- Yufeng Su
- Department of Laboratory Medicine, Key Laboratory of Diagnostic Medicine (Ministry of Education), Chongqing Medical University, Chongqing, China.,Department of Laboratory Medicine, People's Hospital of Changshou, Chongqing, China
| | - Dagen Li
- Department of Laboratory Medicine, Key Laboratory of Diagnostic Medicine (Ministry of Education), Chongqing Medical University, Chongqing, China.,Department of Laboratory Medicine, People's Hospital of Changshou, Chongqing, China
| | - Yan Xing
- Department of Laboratory Medicine, Key Laboratory of Diagnostic Medicine (Ministry of Education), Chongqing Medical University, Chongqing, China
| | - Hong Wang
- Department of Laboratory Medicine, Key Laboratory of Diagnostic Medicine (Ministry of Education), Chongqing Medical University, Chongqing, China
| | - Jian Wang
- Department of Laboratory Medicine, Key Laboratory of Diagnostic Medicine (Ministry of Education), Chongqing Medical University, Chongqing, China
| | - Jun Yuan
- Department of Laboratory Medicine, Key Laboratory of Diagnostic Medicine (Ministry of Education), Chongqing Medical University, Chongqing, China
| | - Xiaofang Wang
- Department of Laboratory Medicine, Key Laboratory of Diagnostic Medicine (Ministry of Education), Chongqing Medical University, Chongqing, China
| | - Fang Cui
- Department of Laboratory Medicine, Key Laboratory of Diagnostic Medicine (Ministry of Education), Chongqing Medical University, Chongqing, China
| | - Yibing Yin
- Department of Laboratory Medicine, Key Laboratory of Diagnostic Medicine (Ministry of Education), Chongqing Medical University, Chongqing, China
| | - Xuemei Zhang
- Department of Laboratory Medicine, Key Laboratory of Diagnostic Medicine (Ministry of Education), Chongqing Medical University, Chongqing, China
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31
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Sings HL. Pneumococcal conjugate vaccine use in adults - Addressing an unmet medical need for non-bacteremic pneumococcal pneumonia. Vaccine 2017; 35:5406-5417. [PMID: 28602602 DOI: 10.1016/j.vaccine.2017.05.075] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 05/04/2017] [Accepted: 05/24/2017] [Indexed: 11/17/2022]
Abstract
Streptococcus pneumoniae is a frequent cause of community acquired pneumonia (CAP), with the largest burden of disease attributed to non-bacteremic pneumonia. Due to the high persistent burden of disease, pneumococcal pneumonia, particularly non-bacteremic pneumococcal pneumonia, continues to be a major public health concern. There are currently two pneumococcal vaccines approved for use in adults in the United States (US) and other countries worldwide: a 23-valent pneumococcal simple polysaccharide vaccine (PPV23), and a 13-valent pneumococcal conjugate vaccine (PCV13). The capsular polysaccharides included in PPV23 induce antibodies primarily by a T-cell independent mechanism, thus the immune response is short lived and lacks the ability to elicit an anamnestic response. PCV13, on the other hand, has the bacterial polysaccharides covalently conjugated to an immunogenic carrier protein resulting in the formation of memory B lymphocytes, thus proving long-acting immunologic memory and an anamnestic response. Despite 30years of use, the question of PPV23 vaccine efficacy, particularly with respect to efficacy for non-bacteremic pneumonia, has been extensively debated and investigated; whereas PCV13 efficacy against vaccine-type pneumococcal CAP, both bacteremic and non-bacteremic, was confirmed in a large randomized controlled trial in older adults. PCV13 was approved under the US Food and Drug Administration's accelerated pathway, which allows for earlier approval of products that provide meaningful benefit over existing treatments - in this case, protection of adults from non-bacteremic pneumococcal pneumonia. Its use is now increasingly recommended globally. This article summarizes the history and use of PPV23 and PCV13 in adults and how vaccination of adults with PCV13 addresses an unmet medical need.
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Seo YB, Choi WS, Lee J, Song JY, Cheong HJ, Kim WJ. Comparison of immunogenicity and safety of an influenza vaccine administered concomitantly with a 13-valent pneumococcal conjugate vaccine or 23-valent polysaccharide pneumococcal vaccine in the elderly. Clin Exp Vaccine Res 2017; 6:38-44. [PMID: 28168172 PMCID: PMC5292355 DOI: 10.7774/cevr.2017.6.1.38] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 11/22/2016] [Accepted: 11/27/2016] [Indexed: 12/01/2022] Open
Abstract
Purpose Previous studies have demonstrated the immunogenicity and safety of the co-administration of the trivalent inactivated influenza vaccine (IIV3) with the polysaccharide pneumococcal vaccine (PPV) or pneumococcal conjugate vaccine (PCV). However, there is no direct comparison study that evaluates the immunogenicity and safety of IIV3 given concomitantly with PCV13 or PPV23 in the elderly. Materials and Methods During the 2012-2013 influenza vaccination period, 224 healthy elderly volunteers aged 65 years and older randomly received IIV3 given concomitantly with either PCV13 (PCV13+IIV3) or PPV23 (PPV23+IIV3) in a 1:1 ratio. Serum hemagglutination-inhibiting antibodies for IIV3 were measured at the time of vaccination and 1 month after vaccination. Adverse events were recorded prospectively in a clinical diary during a 7-day period. Results A total of 220 participants blood samples for analysis of immunogenicity and kept a clinical diary for safety analysis (PCV13+IIV3, n=110; PPV23+IIV3, n=110). One month after vaccination, both groups satisfied the Committee for Medical Products for Human Use criteria for A/H1N1, A/H3N2 and B strains, showing comparable seroprotection rates, seroconversion rates and geometric mean titer fold. The assessments of immunogenicity were similar in both groups. The most common local and systemic reactions were pain at the injection site and generalized myalgia. They were generally mild or moderate in intensity. The adverse events were not statistically different between the two groups. Conclusion PCV13+IIV3 and PPV23+IIV3 demonstrated similar immunogenicity and safety in the elderly.
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Affiliation(s)
- Yu Bin Seo
- Division of Infectious Diseases, Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea
| | - Won Suk Choi
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Jacob Lee
- Division of Infectious Diseases, Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea
| | - Joon Young Song
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.; Asian Pacific Influenza Institute (APII), Seoul, Korea
| | - Hee Jin Cheong
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.; Asian Pacific Influenza Institute (APII), Seoul, Korea
| | - Woo Joo Kim
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.; Asian Pacific Influenza Institute (APII), Seoul, Korea
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33
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Song JY, Cheong HJ, Hyun HJ, Seo YB, Lee J, Wie SH, Choi MJ, Choi WS, Noh JY, Yun JW, Yun JG, Kim WJ. Immunogenicity and safety of a 13-valent pneumococcal conjugate vaccine and an MF59-adjuvanted influenza vaccine after concomitant vaccination in ⩾60-year-old adults. Vaccine 2016; 35:313-320. [PMID: 27919632 DOI: 10.1016/j.vaccine.2016.11.047] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 11/09/2016] [Accepted: 11/13/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Concomitant administration of influenza and pneumococcal vaccines could be an efficient strategy to increase vaccine uptake among older adults. Nevertheless, immune interference and safety issues have been a concern when more than one vaccines are administered at the same time. METHODS Subjects aged ⩾60years were randomized in a 1:1:1 ratio to receive MF59-adjuvanted trivalent inactivated influenza vaccine (MF59-aTIV)+13-valent pneumococcal conjugate vaccine (PCV13) (Group 1), PCV13 alone (Group 2), or MF59-aTIV alone (Group 3). Hemagglutination inhibition (HI) and opsonophagocytic activity (OPA) assays were used to compare immunogenicity after single or concomitant vaccination. RESULTS A total of 1149 subjects (Group 1, N=373; Group 2, N=394; Group 3, N=382) were available for the assessment of immunogenicity and safety. All groups met immunogenicity criteria for the influenza vaccine in older adults with similar seroprotection rates, seroconversion rates, and geometric mean titer (GMT) fold-increases, irrespective of concomitant vaccination. For each pneumococcal serotype, OPA titers increased markedly after the PCV13 vaccination, irrespective of the concomitant influenza vaccination. After concomitant administration, the non-inferiority criteria of GMT ratios were met for all three influenza subtypes and 13 pneumococcal serotypes. No vaccine-related serious adverse events occurred. CONCLUSIONS Concomitant MF59-aTIV and PCV13 administration showed no interference with antibody response and showed good safety profiles. (Clinical Trial Number - NCT02215863).
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Affiliation(s)
- Joon Young Song
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea; Asian Pacific Influenza Institute (APII), Korea University College of Medicine, Seoul, Republic of Korea
| | - Hee Jin Cheong
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea; Asian Pacific Influenza Institute (APII), Korea University College of Medicine, Seoul, Republic of Korea.
| | - Hak Jun Hyun
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Yu Bin Seo
- Hallym University College of Medicine, Seoul, Republic of Korea
| | - Jacob Lee
- Hallym University College of Medicine, Seoul, Republic of Korea
| | - Seong-Heon Wie
- St. Vincent's Hospital, Catholic University of Korea College of Medicine, Suwon, Gyeonggi-do, Republic of Korea
| | - Min Joo Choi
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Won Suk Choi
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Ji Yun Noh
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea; Asian Pacific Influenza Institute (APII), Korea University College of Medicine, Seoul, Republic of Korea
| | - Jae Won Yun
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Jin Gu Yun
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Woo Joo Kim
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea; Asian Pacific Influenza Institute (APII), Korea University College of Medicine, Seoul, Republic of Korea
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34
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Zhao D, Gai Tobe R, Cui M, He J, Wu B. Cost-effectiveness of a 23-valent pneumococcal polysaccharide vaccine immunization programme for the elderly in Shanghai, China. Vaccine 2016; 34:6158-6165. [DOI: 10.1016/j.vaccine.2016.11.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 10/31/2016] [Accepted: 11/01/2016] [Indexed: 10/20/2022]
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35
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Wyllie AL, Rümke LW, Arp K, Bosch AATM, Bruin JP, Rots NY, Wijmenga-Monsuur AJ, Sanders EAM, Trzciński K. Molecular surveillance on Streptococcus pneumoniae carriage in non-elderly adults; little evidence for pneumococcal circulation independent from the reservoir in children. Sci Rep 2016; 6:34888. [PMID: 27713565 PMCID: PMC5054371 DOI: 10.1038/srep34888] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 09/21/2016] [Indexed: 11/30/2022] Open
Abstract
Carriage of Streptococcus pneumoniae in adults is rarely detected by the gold standard culture method. With molecular tests of high sensitivity now available, we analysed upper respiratory tract samples collected during autumn/winter 2012/2013 from parents of PCV7-vaccinated infants and from childless adults, directly comparing culture and qPCR-based S. pneumoniae detection. As compared to the gold standard of testing nasopharyngeal swabs, qPCR-based analysis of oral samples significantly improved detection of pneumococcal carriage (5% versus 20%, p < 0.0001) with higher carriage rates in parents compared to childless adults (34% versus 7%; p < 0.001). Molecular methods also increased the number of serotype-carriage events detected with higher carriage frequencies of serotypes 3 and 7A/F and lower of serotypes 6C/D and 15A/B/C in parents compared to their infant children. We provide evidence that culture-based methods severely underestimate adult carriage rates and for the superiority of testing oral samples over nasopharyngeal swabs. The substantial circulation of pneumococci in parents is however, not representative for the entire adult population. While age-associated differences in serotype carriage suggests reservoirs outside infants as potential sources of vaccine-serotypes contributing to weakening of vaccine herd effects, we find no evidence for reservoirs in adults contributing to serotype replacement in carriage.
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Affiliation(s)
- Anne L Wyllie
- Paediatric Immunology and Infectious Diseases, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Lidewij W Rümke
- Paediatric Immunology and Infectious Diseases, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Kayleigh Arp
- Paediatric Immunology and Infectious Diseases, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Jacob P Bruin
- Regional Laboratory of Public Health, Haarlem, The Netherlands
| | - Nynke Y Rots
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Alienke J Wijmenga-Monsuur
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Elisabeth A M Sanders
- Paediatric Immunology and Infectious Diseases, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands.,Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Krzysztof Trzciński
- Paediatric Immunology and Infectious Diseases, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
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Vila-Corcoles A, Ochoa-Gondar O, Hospital I, de Diego C, Satué E, Bladé J, Ansa X, Guzmán JA, Salsench E, Ramos F. Pneumococcal vaccination coverages among low-, intermediate-, and high-risk adults in Catalonia. Hum Vaccin Immunother 2016; 12:2953-2958. [PMID: 27454779 DOI: 10.1080/21645515.2016.1210744] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
There is scarce data about pneumococcal vaccination coverages among adults in recent years. We investigated current pneumococcal vaccination coverages in Catalonia, Spain, with a cross-sectional population-based study including 2,033,465 individuals aged 50 y or older assigned to the Catalonian Health Institute at 01/01/2015 (date of survey). A previously validated institutional research clinical Database was used to classify study subjects by their vaccination status for both 23-valent pneumococcal polysaccharide vaccine (PPSV23) and 13-valent pneumococcal conjugate vaccine (PCV13), to identify comorbidities and underlying conditions, and establish the risk stratum of each individual: High risk stratum: functional or anatomic asplenia, cochlear implants, CSF leaks, or immunocompromising conditions; medium risk stratum: immunocompetent persons with history of chronic cardiac or respiratory disease, liver disease, diabetes mellitus, alcoholism and/or smoking; low risk stratum: persons without high or medium risk conditions. Of the total 2,033,465 study population, an amount of 789,098 (38.8%) had received PPVS23, whereas 5031 (0.2%) had received PCV13. PPSV23 coverages increased largely with increasing age: 4.8% in 50-59 y vs 35.5% in 60-69 y vs 71.9% in 70-79 y vs 79.5% in 80 y or older; p < 0.001). PCV13 coverages also increased with age, although they were very low in all age groups. PPSV23 coverages were 59.2% in high risk stratum, 48.3% in medium risk stratum and 28.1% in low risk stratum (p < 0.001). For the PCV13, uptakes were 1.2%, 0.3% and 0.1% in high, medium and low stratum, respectively (p < 0.001). In conclusion, pneumococcal vaccination coverages in Catalonian adults are not optimal, being especially small for the PCV13 (even in high-risk subjects).
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Affiliation(s)
- Angel Vila-Corcoles
- a Primary Health Care Service "Camp de Tarragona," Institut Català de la Salut , Tarragona , Spain.,b Primary Care Research Institute (IDIAP Jordi Gol) , Barcelona , Spain
| | - Olga Ochoa-Gondar
- a Primary Health Care Service "Camp de Tarragona," Institut Català de la Salut , Tarragona , Spain.,b Primary Care Research Institute (IDIAP Jordi Gol) , Barcelona , Spain
| | - Imma Hospital
- a Primary Health Care Service "Camp de Tarragona," Institut Català de la Salut , Tarragona , Spain
| | - Cinta de Diego
- a Primary Health Care Service "Camp de Tarragona," Institut Català de la Salut , Tarragona , Spain
| | - Eva Satué
- a Primary Health Care Service "Camp de Tarragona," Institut Català de la Salut , Tarragona , Spain
| | - Jordi Bladé
- a Primary Health Care Service "Camp de Tarragona," Institut Català de la Salut , Tarragona , Spain
| | - Xabier Ansa
- a Primary Health Care Service "Camp de Tarragona," Institut Català de la Salut , Tarragona , Spain
| | - Jorge A Guzmán
- a Primary Health Care Service "Camp de Tarragona," Institut Català de la Salut , Tarragona , Spain
| | - Elisabet Salsench
- a Primary Health Care Service "Camp de Tarragona," Institut Català de la Salut , Tarragona , Spain
| | - Francisca Ramos
- c Information System for Primary Care Services , Institut Català de la Salut , Barcelona , Spain
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Guimarães M, Bugalho A, Oliveira AS, Moita J, Marques A. COPD control: Can a consensus be found? REVISTA PORTUGUESA DE PNEUMOLOGIA 2016; 22:167-76. [PMID: 27004479 DOI: 10.1016/j.rppnen.2016.01.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Revised: 12/18/2015] [Accepted: 01/05/2016] [Indexed: 11/24/2022] Open
Abstract
There are currently no reliable instruments for assessing the onset and progression of chronic obstructive pulmonary disease (COPD) or predicting its prognosis. Currently, a comprehensive assessment of COPD including several objective and subjective parameters is recommended. However, the lack of biomarkers precludes a correct assessment of COPD severity, which consequently hampers adequate therapeutic approaches and COPD control. In the absence of a definition of "well-controlled disease", a consensus regarding COPD control will be difficult to reach. However, COPD patient assessment should be multidimensional, and anchored in five points: control of symptoms, decline of pulmonary function, levels of physical activity, exacerbations, and Quality of Life. Several non-pharmacological and pharmacological measures are currently available to achieve disease control. Smoking cessation, vaccination, exercise training programs and pulmonary rehabilitation are recognized as important non-pharmacological measures but bronchodilators are the pivotal therapy in the control of COPD. This paper discusses several objective and subjective parameters that may bridge the gap between disease assessment and disease control. The authors conclude that, at present, it is not possible to reach a consensus regarding COPD control, essentially due to the lack of objective instruments to measure it. Some recommendations are set forth, but true COPD control awaits further objective assessments.
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Affiliation(s)
- M Guimarães
- Pulmonology Department, Centro Hospitalar Gaia-Espinho, EPE, Portugal.
| | - A Bugalho
- Pulmonology Department, Hospital CUF Infante Santo/Hospital CUF Descobertas, Lisbon, Portugal; Chronic Diseases Research Center (CEDOC), Lisbon School of Medical Sciences, Nova University, Lisbon, Portugal.
| | - A S Oliveira
- Pulmonology Department, Hospital Pulido Valente, CHLN, Lisbon, Portugal.
| | - J Moita
- General Hospital, Coimbra University Hospital Center, Portugal.
| | - A Marques
- Pulmonology Department, São João Hospital Center, Oporto Medical School, Porto, Portugal.
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Abstract
Streptococcus pneumoniae (the pneumococcus) is an important human pathogen. Its virulence is largely due to its polysaccharide capsule, which shields it from the host immune system, and because of this, the capsule has been extensively studied. Studies of the capsule led to the identification of DNA as the genetic material, identification of many different capsular serotypes, and identification of the serotype-specific nature of protection by adaptive immunity. Recent studies have led to the determination of capsular polysaccharide structures for many serotypes using advanced analytical technologies, complete elucidation of genetic basis for the capsular types, and the development of highly effective pneumococcal conjugate vaccines. Conjugate vaccine use has altered the serotype distribution by either serotype replacement or switching, and this has increased the need to serotype pneumococci. Due to great advances in molecular technologies and our understanding of the pneumococcal genome, molecular approaches have become powerful tools to predict pneumococcal serotypes. In addition, more-precise and -efficient serotyping methods that directly detect polysaccharide structures are emerging. These improvements in our capabilities will greatly enhance future investigations of pneumococcal epidemiology and diseases and the biology of colonization and innate immunity to pneumococcal capsules.
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Contreras CL, Verani JR, Lopez MR, Paredes A, Bernart C, Moscoso F, Roldan A, Arvelo W, Lindblade KA, McCracken JP. Incidence of Hospitalized Pneumococcal Pneumonia among Adults in Guatemala, 2008-2012. PLoS One 2015; 10:e0140939. [PMID: 26488871 PMCID: PMC4619266 DOI: 10.1371/journal.pone.0140939] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 09/30/2015] [Indexed: 11/21/2022] Open
Abstract
Background Streptococcus pneumoniae is a leading cause of pneumonia worldwide. However, the burden of pneumococcal pneumonia among adults in low- and middle-income countries is not well described. Methods Data from 2008–2012 was analyzed from two surveillance sites in Guatemala to describe the incidence of pneumococcal pneumonia in adults. A case of hospitalized pneumococcal pneumonia was defined as a positive pneumococcal urinary antigen test or blood culture in persons aged ≥ 18 years hospitalized with an acute respiratory infection (ARI). Results Among 1595 adults admitted with ARI, 1363 (82%) had either urine testing (n = 1286) or blood culture (n = 338) performed. Of these, 188 (14%) had pneumococcal pneumonia, including 173 detected by urine only, 8 by blood culture only, and 7 by both methods. Incidence rates increased with age, with the lowest rate among 18–24 year-olds (2.75/100,000) and the highest among ≥65 year-olds (31.3/100,000). The adjusted incidence of hospitalized pneumococcal pneumonia was 18.6/100,000 overall, with in-hospital mortality of 5%. Conclusions An important burden of hospitalized pneumococcal pneumonia in adults was described, particularly for the elderly. However, even adjusted rates likely underestimate the true burden of pneumococcal pneumonia in the community. These data provide a baseline against which to measure the indirect effects of the 2013 introduction of the pneumococcal conjugate vaccine in children in Guatemala.
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Affiliation(s)
- Carmen Lucía Contreras
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala
- * E-mail:
| | - Jennifer R. Verani
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States of America
| | - María Renee Lopez
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | - Antonio Paredes
- National Center for Epidemiology, Ministry of Public Health and Social Welfare (MSPAS), Guatemala City, Guatemala
| | - Chris Bernart
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | - Fabiola Moscoso
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | - Aleida Roldan
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | - Wences Arvelo
- Division of Global Disease Detection and Emergency Response, Centers for Disease Control and Prevention (CDC), Atlanta GA, United States of America
| | - Kim A. Lindblade
- Division of Global Disease Detection and Emergency Response, Centers for Disease Control and Prevention (CDC), Atlanta GA, United States of America
| | - John P. McCracken
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala
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Bryant K, Frenck R, Gurtman A, Rubino J, Treanor J, Thompson A, Jones T, Sundaraiyer V, Baxter L, Gruber W, Emini E, Scott D, Schmoele-Thoma B. Immunogenicity and safety of a 13-valent pneumococcal conjugate vaccine in adults 18–49 years of age, naive to 23-valent pneumococcal polysaccharide vaccine. Vaccine 2015; 33:5854-5860. [DOI: 10.1016/j.vaccine.2015.08.080] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Revised: 08/25/2015] [Accepted: 08/28/2015] [Indexed: 11/25/2022]
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Liu S, Xu E, Liu Y, Xu Y, Wang J, Du J, Zhang X, Che X, Gu W. Factors associated with pneumococcal vaccination among an urban elderly population in China. Hum Vaccin Immunother 2015; 10:2994-9. [PMID: 25483646 DOI: 10.4161/21645515.2014.972155] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES To investigate the coverage of the 23-valent pneumococcal polysaccharide vaccine (23-PPV) in the Chinese urban elderly population and to understand the attitudes, knowledge and beliefs of this population toward the 23-PPV vaccination. METHODS A cross-sectional approach was employed to survey the willingness of this population to receive the 23-PPV vaccination. Two thousand 9 hundred 2 six subjects over the age of 60 y were enrolled via a multi-stage random sampling method from the urban community population in Hangzhou, China. The relationships between the variables and the willingness to receive the 23-PPV vaccination were computed as odds ratios (ORs) by multivariate analysis. RESULTS Of the participants, 21.77% were willing to undergo 23-PPV vaccination, and 61.65% of the subjects agreed that pneumonia is a serious disease among elderly people. The rate of reasonable perceptions about vaccination, including the perception about vaccine efficacy and safety, among the subjects was below 50%. Only 1.23% of subjects had been vaccinated with 23-PPV, and a similarly low rate was observed for the seasonal influenza vaccine (4.17%). The factors that were independently related to the willingness to receive the 23-PPV vaccine included consensus with the hazards of pneumonia (OR = 1.67, 95% CI: 1.28 - 2.17), the safety of vaccination (OR = 2.00, 95% CI: 1.54 - 2.59), advice about the 23-PPV vaccination from family members (OR = 2.37, 95% CI: 1.39 - 4.40), influenza vaccination history (OR = 2.57, 95% CI: 1.66 - 3.98) and pneumococcal vaccination history (OR = 7.48, 95% CI: 2.4-22.92). CONCLUSION The administration of the 23-PPV vaccine among the urban elderly population is not optimistic in China. Emphasis on persuasion from families and the improvement of knowledge about vaccination might encourage elderly people to get the 23-PPV vaccination. Suggestions from physicians did not affect the participants' willingness to get the 23-PPV vaccination in multivariate analysis, but elderly people typically visited the Community Health Center (CHC) in their residential districts, and thus, systematic encouragement from healthcare physicians might be the key to increasing 23-PPV vaccination.
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Affiliation(s)
- Shijun Liu
- a Hangzhou Center for Disease Control and Prevention ; Hangzhou , China
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van der Linden M, Falkenhorst G, Perniciaro S, Imöhl M. Effects of Infant Pneumococcal Conjugate Vaccination on Serotype Distribution in Invasive Pneumococcal Disease among Children and Adults in Germany. PLoS One 2015; 10:e0131494. [PMID: 26132078 PMCID: PMC4488910 DOI: 10.1371/journal.pone.0131494] [Citation(s) in RCA: 94] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 06/01/2015] [Indexed: 11/19/2022] Open
Abstract
This study describes the effects of the introduction of universal infant pneumococcal conjugate vaccination in 2006 on invasive pneumococcal disease (IPD) among children and adults in Germany with a focus on the dynamics of serotype distribution in vaccinated and non-vaccinated age groups. Over a period of 22 years (1992-2014), microbiological diagnostic laboratories from all over Germany have been sending isolates of IPD cases to the German National Reference Center for Streptococci on a voluntary basis. Streptococcus pneumoniae isolates were serotyped using Neufeld's Quellung method. Among children <16 years, the proportion of PCV7 serotypes among isolates from IPD cases decreased from 61.8% before vaccination (1997-2006) to 23.5% in the early vaccination period (2007-2010; p = 1.30E-72) and sank further to 5.2% in the late vaccination period (2010-2014; p = 4.59E-25). Similar reductions were seen for the separate age groups <2 years, 2-4 years and 5-15 years. Among adults, the proportion of PCV7 serotypes decreased from 43.4% in the pre-vaccination period (1992-2006) to 24.7% (p = 3.78E-88) in the early vaccination period and 8.2% (p = 5.97E-161) in the late vaccination period. Both among children and among adults, the non-PCV7 serotypes 1, 3, 7F and 19A significantly increased in the early vaccination period. After the switch from PCV7 to PVC10/PCV13 for infant vaccination in 2010, serotypes 1, 6A and 7F significantly decreased. A decrease in serotype 19A was only observed in 2013-2014, as compared to 2010-2011 (children p = 4.16E-04, adults p = 6.98E-06). Among adults, serotype 3, which strongly increased in the early vaccination period (p = 4.44E-15), remained at a constant proportion in the late vaccination period. The proportion of non-PCV13 vaccine serotypes increased over the whole vaccination period, with serotypes 10A, 12F, 23B, 24F and 38 most significantly increasing among children and serotypes 6C, 12F, 15A, 22F and 23B increasing among adults. Eight years of childhood pneumococcal conjugate vaccination have had a strong effect on the pneumococcal population in Germany, both among the target group for vaccination as well as among older children and adults.
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Affiliation(s)
- Mark van der Linden
- National Reference Center for Streptococci, Department of Medical Microbiology, University Hospital (RWTH), Aachen, Germany
- * E-mail:
| | - Gerhard Falkenhorst
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Stephanie Perniciaro
- National Reference Center for Streptococci, Department of Medical Microbiology, University Hospital (RWTH), Aachen, Germany
| | - Matthias Imöhl
- National Reference Center for Streptococci, Department of Medical Microbiology, University Hospital (RWTH), Aachen, Germany
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Song JY, Cheong HJ, Tsai TF, Chang HA, Choi MJ, Jeon JH, Kang SH, Jeong EJ, Noh JY, Kim WJ. Immunogenicity and safety of concomitant MF59-adjuvanted influenza vaccine and 23-valent pneumococcal polysaccharide vaccine administration in older adults. Vaccine 2015; 33:4647-52. [PMID: 25980426 DOI: 10.1016/j.vaccine.2015.05.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 04/20/2015] [Accepted: 05/04/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Concomitant administration of influenza and pneumococcal vaccines facilitates their uptake by older adults; however, data on immunogenicity and safety of concomitant administration of adjuvanted trivalent inactivated influenza vaccine (aIIV3) and 23-valent pneumococcal polysaccharide vaccine (PPSV23) have not been reported. METHODS Subjects aged ≥65 years (N=224) were randomized 1:1:1:1 to receive MF59-aIIV3 alone, MF59-aIIV3+PPSV23 in contralateral arms, MF59-aIIV3+PPSV23 in the same arm or PPSV23 alone (Clinical Trial Number - NCT02225327). Hemagglutination inhibition assay and multiplex opsonophagocytic killing assay were used to compare immunogenicity after single or concomitant vaccination. RESULTS All groups met immunogenicity criteria for the influenza vaccine in older adults with similar seroconversion rates and geometric mean fold-increases, irrespective of concomitant vaccinations and injection site. For each pneumococcal serotype, opsonic index (OI) increased markedly after the PPSV23 vaccination, irrespective of the concomitant influenza vaccine. All subjects showed an OI≥8 for serotypes 6B, 18C and 19A post-vaccination, with a suggestion that the ipsilateral concomitant vaccination might be associated with higher OIs for some antigens. Local and systemic adverse events were more common in subjects receiving PPSV23 compared to those receiving aIIV3 alone. CONCLUSIONS No interference was observed with antibody responses to influenza or pneumococcal antigens when aIIV3 and PPSV23 were administered concomitantly.
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Affiliation(s)
- Joon Young Song
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea; Asian Pacific Influenza Institute (APII), Korea University College of Medicine, Seoul, Republic of Korea.
| | - Hee Jin Cheong
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea; Asian Pacific Influenza Institute (APII), Korea University College of Medicine, Seoul, Republic of Korea.
| | - T F Tsai
- Novartis Vaccines, Cambridge, MA, USA
| | | | - Min Joo Choi
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Ji Ho Jeon
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Seong Hee Kang
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Eun Ju Jeong
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Ji Yun Noh
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea; Asian Pacific Influenza Institute (APII), Korea University College of Medicine, Seoul, Republic of Korea
| | - Woo Joo Kim
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea; Asian Pacific Influenza Institute (APII), Korea University College of Medicine, Seoul, Republic of Korea
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Pneumococcal vaccines: understanding centers for disease control and prevention recommendations. Ann Am Thorac Soc 2015; 11:980-5. [PMID: 25032872 DOI: 10.1513/annalsats.201401-042cme] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Streptococcus pneumoniae infection is a common and serious health problem that is best prevented by the pneumococcal vaccine. The first vaccine approved by the U.S. Federal Drug Administration in 1977 contained 14 polysaccharide antigens. An improved vaccine introduced in 1983 included 23 polysaccharide antigens. Both vaccines were effective for immunocompetent adults; however, young children and immunocompromised adults remained susceptible. A pediatric vaccine was developed consisting of the capsular antigens of seven pneumococcal serotypes commonly found in children. The antigens in this preparation are covalently conjugated to diphtheria protein to make them more antigenic. The conjugate vaccine was expanded to include 13 serotypes by 2010. Although more immunogenic, the conjugate vaccine has fewer serotypes than the older 23-valent vaccine. The U.S. Centers for Disease Control and Prevention recommend that children at risk for pneumococcal pneumonia as defined by the presence of chronic disease should receive the 13-valent conjugated vaccine. Adults at risk for pneumococcal pneumonia, which includes those over 65 years of age and those who have a chronic disease, should receive the 23-polysaccharide vaccine. Immunosuppressed patients of any age should receive both vaccines. Adults should be revaccinated once at age 65 years or older with the 23-polysaccharide vaccine provided that at least 5 years have elapsed since the previous vaccination.
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Abstract
The age-associated increased susceptibility to infectious disease would suggest that vaccination should be a route to promote healthy aging and keep our seniors autonomous and independent. While vaccination represents a cost-effective and efficient strategy at community level, the ability of the immune system to mount a protective immune response is still unpredictable at the level of the individual. Thus, at a similar age, some individuals, including the elderly, might still be 'good' responders while some other, even younger, would definitely fail to mount a protective response. In this review, the current burden of vaccine-preventable diseases in the aging and aged population will be detailed with the aim to identify the ideal vaccine candidates over the age of 50 years. This article will conclude with potential strategies to reduce, as best as possible, this burden and the imperative need to overcome barriers in extending current vaccine coverage towards to a lifelong vaccine schedule.
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Affiliation(s)
- Pierre-Olivier Lang
- Translational Medicine Research group, Cranfield Health, Cranfield University, Cranfield, England,
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46
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Ramirez M. Streptococcus pneumoniae. MOLECULAR MEDICAL MICROBIOLOGY 2015:1529-1546. [DOI: 10.1016/b978-0-12-397169-2.00086-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Durando P, Rosselli R, Cremonesi I, Orsi A, Albanese E, Barberis I, Paganino C, Trucchi C, Martini M, Marensi L, Turello V, Study Group TLP, Bregante A, Cacciani R, Iudici R, La Marca D, Pedano L, Petrucci AF, Santolini M, Sbisà V, Zacconi M. Safety and tolerability of 13-valent pneumococcal conjugate vaccine in the elderly. Hum Vaccin Immunother 2014; 11:172-7. [PMID: 25483531 DOI: 10.4161/hv.34420] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In September 2011 the European Medical Agency authorized the use of 13-valent pneumococcal conjugate vaccine (PCV13) in adults aged ≥50 years. The same occurred in the US in December 2011 when the Food and Drug Administration approved the use of PCV13 in the same target age-group with indication for the prevention of invasive pneumococcal diseases and community acquired pneumonia sustained by the serotypes contained in the vaccine. The Liguria Region, in Italy, implemented in 2013 an active and free of charge immunization strategy with PCV13 among adults affected by specific risk conditions and the elderly aged ≥70 years. METHODS An observational study was performed in order to assess the safety and tolerability of PCV13 among elderly dwelling in the metropolitan area of Genoa, the capital city of Liguria Region. Eligible subjects, who received PCV13 following the public health immunization campaign at the Local Health Unit 3 of Genoa, provided a written informed consent to take part in the study. Eight-hundred-seventy-one subjects were enrolled between October 2013 and May 2014: all were monitored by qualified healthcare personnel for at least 30 min after vaccination at the outpatient clinics, in order to assess any possible sudden reaction. The occurrence of a series of local and systemic solicited reactions and of any unsolicited Adverse Events (AEs) was monitored using a self-administered clinical diary and by regular phone contacts up to 14 and 21 d following immunization, respectively. Moreover, a 6-months follow-up following vaccination was planned in order to monitor Severe Adverse Events (SAEs). RESULTS No sudden reaction occurred in vaccinees at the outpatient clinics. Pain (27.4%) was the most frequent reaction reported by subjects at the injection site, while new muscle pain (13.6%), fatigue (10.7%), and headache (9.9%) resulted the most common systemic reactions. Rates of the main reactions reported in this on-field study resulted generally lower than those registered in clinical trials performed in the elderly. The incidence of fever (2.2%) following vaccination was low at values superimposable to that reported in previous studies. CONCLUSION This observational study showed a good safety and tolerability of PCV13 among the elderly in routine clinical practice further confirming the evidence coming from clinical trials in the same age-group.
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Affiliation(s)
- Paolo Durando
- a Department of Health Sciences, Vaccines and Clinical Trials Unit; University of Genoa, Italy; I.R.C.C.S. A.O.U. San Martino - IST of Genoa; Italy and Integrated Group for the Development of Vaccine Sciences (GISVa); Genoa, Italy
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Abstract
Vaccination of children has had a major impact on the morbidity and mortality of many infectious diseases globally. However, with age, immune responses to vaccines can be less robust, which can be further enhanced by underlying diseases that are common in the older adult. In many countries around the globe booster vaccinations against diphtheria, tetanus, and pertussis are recommended for adults. For the older adult, vaccination against pneumococcal diseases, influenza and herpes zoster are also recommended. Despite these recommendations, the widespread use of these vaccines in the adult population clearly lags behind the vaccine uptake and successes documented for pediatric vaccination programs. Furthermore, extensive and sometimes inappropriate use of antibiotics have fostered the emergence of antibiotic-resistant bacteria (e.g., methicillin resistant Staphylococcus aureus (MRSA)) as well as increased susceptibility in the elderly to bacterial species such as Clostridium difficile. Infectious diseases remain an important unmet medical need and new concepts to successfully implement vaccination of adults are urgently needed.
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Affiliation(s)
- Kena A Swanson
- a Pfizer Vaccine Research and Early Development; Pearl River, NY USA
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Recommendations for pneumococcal immunization outside routine childhood immunization programs in Western Europe. Adv Ther 2014; 31:1011-44. [PMID: 25300593 PMCID: PMC4209094 DOI: 10.1007/s12325-014-0157-1] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Indexed: 11/16/2022]
Abstract
The global burden of pneumococcal diseases is high, with young children and adults ≥50 years of age at highest risk of infection. Two types of vaccine are available for the prevention of pneumococcal diseases caused by specific Streptococcus pneumoniae serotypes: the pneumococcal polysaccharide vaccine (PPV23) and the pneumococcal conjugate vaccine (PCV7, PCV10, and PCV13). Despite pneumococcal immunization programs in adults and children, the burden in adults has remained high. Most European countries have national or local/regional vaccination recommendations. The objective of this review was to provide an overview of the government recommendations for pneumococcal vaccination outside routine childhood vaccination programs for 16 Western European countries as of August 2014. We found that recommendations for pneumococcal immunization across Europe are complex and vary greatly among countries in terms of age groups and risk groups recommended for vaccination, as well as which vaccine should be administered. Clarifying or simplifying these recommendations and improving their dissemination could help to increase pneumococcal vaccine uptake and decrease the high burden of pneumococcal diseases in adults, both through a direct effect of the vaccine and via a herd effect in unvaccinated individuals.
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50
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Feldman C, Anderson R. Review: Current and new generation pneumococcal vaccines. J Infect 2014; 69:309-25. [DOI: 10.1016/j.jinf.2014.06.006] [Citation(s) in RCA: 141] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Accepted: 06/16/2014] [Indexed: 12/22/2022]
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