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Grewal R, Hillier K, Deeks SL, Yeung AH, Wilson SE, Wijayasri S, Harris TM, Buchan SA. Invasive Pneumococcal Disease Epidemiology and Serotype Replacement After the Introduction of the 13-Valent Pneumococcal Conjugate Vaccine in Ontario, Canada, 2007-2022. Open Forum Infect Dis 2024; 11:ofae275. [PMID: 38868312 PMCID: PMC11167672 DOI: 10.1093/ofid/ofae275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 05/13/2024] [Indexed: 06/14/2024] Open
Abstract
Background New vaccine products were recently authorized for protection against invasive pneumococcal disease (IPD) in Canada. Our aim was to determine age- and serotype-specific trends in IPD incidence and severity in Canada's largest province, Ontario. Methods We included all confirmed IPD cases reported in Ontario and defined the pre-pneumococcal 13-valent conjugate vaccine (PCV13) era (01/2007 to 12/2010), post-PCV13 era (01/2011 to 12/2019), and coronavirus disease 2019 (COVID-19) pandemic era (01/2020 to 12/2022). We estimated incidence, hospitalization, and case fatality rate (CFR) by age. We grouped IPD cases by vaccine-specific serotypes (PCV13; PCV15-non-PCV13; PCV20-non-PCV13; PCV20-non-PCV15; polysaccharide 23-valent vaccine-non-PCV20; and non-vaccine-preventable [NVP]). We then compared incidence rates by age and serotype group in the pre- and post-PCV13 eras by calculating rate ratios (RRs) and their 95% CIs. Results Incidence and hospitalizations declined from the pre- to post-PCV13 era in children aged <5 years (RR, 0.7; 95% CI, 0.6-0.8; and RR, 0.8; 95% CI, 0.7-0.9, respectively), but the CFR increased (1.4% to 2.3%). Other age groups saw smaller declines or more stable incidence rates across the years; hospitalizations increased in adults aged 50-64 years (RR, 1.2; 95% CI, 1.1-1.4) and ≥65 years (RR, 1.1; 95% CI, 1.0-1.1). For all ages, IPD cases and hospitalizations attributable to PCV13 serotypes declined, and those attributable to PCV15-non-PCV13, PCV20-non-PCV13, and NVP serotypes increased. IPD incidence declined during the COVID-19 era. Conclusions IPD incidence and hospitalizations due to PCV13 serotypes decreased after PCV13 introduction but increased for other serotypes. Continued surveillance is required to evaluate changes to pneumococcal vaccination programs and ongoing changes to the distribution of IPD-causing serotypes.
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Affiliation(s)
- Ramandip Grewal
- Health Protection, Public Health Ontario, Toronto, Ontario, Canada
- Centre for Vaccine Preventable Diseases, University of Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Kelty Hillier
- Health Protection, Public Health Ontario, Toronto, Ontario, Canada
| | - Shelley L Deeks
- Department of Health and Wellness, Nova Scotia, Halifax, Nova Scotia, Canada
| | - Allison H Yeung
- Centre for Immunization Surveillance, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Sarah E Wilson
- Health Protection, Public Health Ontario, Toronto, Ontario, Canada
- Centre for Vaccine Preventable Diseases, University of Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Shinthuja Wijayasri
- Centre for Immunization Surveillance, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Tara M Harris
- Health Protection, Public Health Ontario, Toronto, Ontario, Canada
| | - Sarah A Buchan
- Health Protection, Public Health Ontario, Toronto, Ontario, Canada
- Centre for Vaccine Preventable Diseases, University of Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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3
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Goretzki SC, van der Linden M, Itzek A, Hühne T, Adelmann RO, Ala Eldin F, Albarouni M, Becker JC, Berghäuser MA, Boesing T, Boeswald M, Brasche M, Brevis Nuñez F, Camara R, Deibert C, Dohle F, Dolgner J, Dziobaka J, Eifinger F, Elting N, Endmann M, Engelmann G, Frenzke H, Gappa M, Gharavi B, Goletz C, Hahn E, Heidenreich Y, Heimann K, Hensel KO, Hoffmann HG, Hoppenz M, Horneff G, Klassen H, Koerner-Rettberg C, Längler A, Lenz P, Lohmeier K, Müller A, Niemann F, Paulussen M, Pentek F, Perez R, Pingel M, Repges P, Rothoeft T, Rübo J, Schade H, Schmitz R, Schonhoff P, Schwade JN, Schwarz T, Seiffert P, Selzer G, Spille U, Thiel C, Thimm A, Urgatz B, van den Heuvel A, van Hop T, Giesen V, Wirth S, Wollbrink T, Wüller D, Felderhoff-Müser U, Dohna-Schwake C, Lâm TT, Claus H, Bruns N. Outbreak of severe community-acquired bacterial infections among children in North Rhine-Westphalia (Germany), October to December 2022. Infection 2024; 52:1099-1111. [PMID: 38366304 PMCID: PMC11143032 DOI: 10.1007/s15010-023-02165-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 12/21/2023] [Indexed: 02/18/2024]
Abstract
PURPOSE In late 2022, a surge of severe S. pyogenes infections was reported in several European countries. This study assessed hospitalizations and disease severity of community-acquired bacterial infections with S. pyogenes, S. pneumoniae, N. meningitidis, and H. influenzae among children in North Rhine-Westphalia (NRW), Germany, during the last quarter of 2022 compared to long-term incidences. METHODS Hospital cases due to bacterial infections between October and December 2022 were collected in a multicenter study (MC) from 59/62 (95%) children's hospitals in NRW and combined with surveillance data (2016-2023) from the national reference laboratories for streptococci, N. meningitidis, and H. influenzae. Overall and pathogen-specific incidence rates (IR) from January 2016 to March 2023 were estimated via capture-recapture analyses. Expected annual deaths from the studied pathogens were calculated from national death cause statistics. RESULTS In the MC study, 153 cases with high overall disease severity were reported with pneumonia being most common (59%, n = 91). IRs of bacterial infections declined at the beginning of the COVID-19 pandemic and massively surged to unprecedented levels in late 2022 and early 2023 (overall hospitalizations 3.5-fold), with S. pyogenes and S. pneumoniae as main drivers (18-fold and threefold). Observed deaths during the study period exceeded the expected number for the entire year in NRW by far (7 vs. 0.9). DISCUSSION The unprecedented peak of bacterial infections and deaths in late 2022 and early 2023 was caused mainly by S. pyogenes and S. pneumoniae. Improved precautionary measures are needed to attenuate future outbreaks.
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Affiliation(s)
- Sarah C Goretzki
- Department of Pediatrics I (Neonatology, Pediatric Intensive Care, Pediatric Neurology, and Pediatric Infectious Diseases), University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Mark van der Linden
- German Reference Laboratory for Streptococci, Department of Medical Microbiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Andreas Itzek
- German Reference Laboratory for Streptococci, Department of Medical Microbiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Tom Hühne
- Department of Pediatrics I (Neonatology, Pediatric Intensive Care, Pediatric Neurology, and Pediatric Infectious Diseases), University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Roland O Adelmann
- Department of General Pediatrics, Klinikum Oberberg, Kreiskrankenhaus Gummersbach, Gummersbach, Germany
| | - Firas Ala Eldin
- Department of General Pediatrics, Helios Hospital Schwelm, Schwelm, Germany
| | - Mohamed Albarouni
- Department of General Pediatrics, Marien-Hospital Gelsenkirchen, Gelsenkirchen, Germany
| | | | - Martin A Berghäuser
- Division of Pediatric Intensive Care, Department of Pediatrics, Florence Nightingale Hospital Kaiserswerth, Düsseldorf, Germany
| | - Thomas Boesing
- Division of Pediatric Intensive Care, Department of Pediatrics, Protestant Hospital Bethel, University of Bielefeld, Bielefeld, Germany
| | - Michael Boeswald
- Department of Pediatrics, Sankt Franziskus Hospital Münster, Münster, Germany
| | - Milian Brasche
- Division of Neonatology, Department of Pediatrics, University Hospital, RWTH University of Aachen, Aachen, Germany
| | - Francisco Brevis Nuñez
- Division of Pediatric Intensive Care, Department of Pediatrics, Sana Hospitals Duisburg, Duisburg, Germany
| | - Rokya Camara
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, GFO Hospital Bonn, Bonn, Germany
| | - Clara Deibert
- Department of General Pediatrics, DRK Hospital Kirchen, Kirchen, Germany
| | - Frank Dohle
- Department of Pediatrics, Pediatric Intensive Care Medicine, St. Vinzenz Hospital Paderborn, Paderborn, Germany
| | - Jörg Dolgner
- Department of General Pediatrics, GFO Hospital Dinslaken, Dinslaken, Germany
| | - Jan Dziobaka
- Department of Microbiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Frank Eifinger
- Division of Pediatric Intensive Care, Department of Pediatrics, University Hospital, University of Cologne, Cologne, Germany
| | - Natalie Elting
- Department of General Pediatrics, Evangelical Hospital Oberhausen, Oberhausen, Germany
| | - Matthias Endmann
- Department of General Pediatrics, St. Franziskus-Hospital Ahlen, Ahlen, Germany
| | - Guido Engelmann
- Department of General Pediatrics, Lukas-Hospital Neuss, Neuss, Germany
| | - Holger Frenzke
- Department of General Pediatrics, Märkisch Hospital Lüdenscheid, Lüdenscheid, Germany
| | - Monika Gappa
- Department of General Pediatrics, Evangelical Hospital Düsseldorf, Düsseldorf, Germany
| | - Bahman Gharavi
- Department of General Pediatrics, Marien-Hospital Witten, Witten, Germany
| | - Christine Goletz
- Department of General Pediatrics, Städtische Kliniken Mönchengladbach, Elisabeth-Hospital Rheydt, Mönchengladbach, Germany
| | - Eva Hahn
- Department of Pediatrics and Adolescent Medicine, Sankt Agnes Hospital, Bocholt, Germany
| | | | - Konrad Heimann
- Division of Neonatology, Department of Pediatrics, University Hospital, RWTH University of Aachen, Aachen, Germany
| | - Kai O Hensel
- Division of Pediatric Intensive Care, Department of Pediatrics, Helios University Hospital Wuppertal, Witten/Herdecke University, Wuppertal, Germany
| | | | - Marc Hoppenz
- Division of Pediatric Intensive Care, Department of Pediatrics, Children's Hospital, Amsterdamer Str., Cologne, Germany
| | - Gerd Horneff
- Department of Pediatrics, Asklepios Clinic Sankt Augustin GmbH, Sankt Augustin, Germany
| | - Helene Klassen
- Department of Pediatrics and Adolescent Medicine, Hochsauerland Hospital, Arnsberg, Germany
| | | | - Alfred Längler
- Department of Pediatrics, Gemeinschaftskrankenhaus Herdecke, University of Witten/Herdecke, Herdecke, Germany
| | - Pascal Lenz
- Department of General Pediatrics, Hospital Leverkusen GmbH, Leverkusen, Germany
| | - Klaus Lohmeier
- Division of Neonatology and Pediatric Cardiology, Department of General Pediatrics, Heinrich Heine University, Düsseldorf, Germany
| | - Andreas Müller
- Department of Neonatology and Pediatric Intensive Care Medicine, University of Bonn, Bonn, Germany
| | - Frank Niemann
- Department of General Pediatrics, Marien-Hospital Gelsenkirchen, Gelsenkirchen, Germany
| | - Michael Paulussen
- Division of Oncology and Haematology, Department of General Pediatrics, Hospital of Children and Adolescents, University of Witten/Herdecke, Datteln, Germany
| | - Falk Pentek
- Department of Pediatrics, Elisabeth-Hospital Essen, Essen, Germany
| | - Ruy Perez
- Division of Pediatric Intensive Care, Department of Pediatrics, Helios Hospital Krefeld, Krefeld, Germany
| | - Markus Pingel
- Department of General Pediatrics, DRK Hospital Siegen gGmbH, Siegen, Germany
| | - Philip Repges
- Department of General Pediatrics, Porz, Cologne, Germany
| | - Tobias Rothoeft
- Division of Neonatology and Pediatric Intensive Care, University Children's Hospital, Ruhr University of Bochum, Bochum, Germany
| | - Jochen Rübo
- Department of General Pediatrics, St. Antonius Hospital Kleve, Kleve, Germany
| | - Herbert Schade
- Department of General Pediatrics, Hospital Mechernich GmbH, Mechernich, Germany
| | - Robert Schmitz
- Department of Pediatrics, Helios Clinic Duisburg, Duisburg, Germany
| | - Peter Schonhoff
- Department of Pediatrics, Clemenshospital Münster, Münster, Germany
| | - Jan N Schwade
- Department of General Pediatrics, Evangelical Hospital Lippstadt, Lippstadt, Germany
| | - Tobias Schwarz
- Department of General Pediatrics, Municipal Hospital Solingen, Solingen, Germany
| | - Peter Seiffert
- Department of Pediatrics, Helios Clinic Duisburg, Duisburg, Germany
| | - Georg Selzer
- Division of Neonatology and Pediatric Intensive Care, Evangelical Hospital Hamm, Hamm, Germany
| | - Uwe Spille
- Department of General Pediatrics, Herford, Germany
| | - Carsten Thiel
- Department of Pediatrics, St.-Clemens-Hospital Geldern, Geldern, Germany
| | - Ansgar Thimm
- Department of General Pediatrics, Sana-Hospital Remscheid, Remscheid, Germany
| | | | - Alijda van den Heuvel
- Division of Pediatric Intensive Care, Department of Pediatrics, University Hospital Münster, Münster, Germany
| | - Tan van Hop
- Department of General Pediatrics, Hospital Oberhausen Sterkrade gGmbH, Oberhausen, Germany
| | - Verena Giesen
- Department of General Pediatrics, Bethanien Hospital Moers, Moers, Germany
| | - Stefan Wirth
- Department of Pediatrics, Helios Medical Center Niederberg, Velbert, Germany
| | - Thomas Wollbrink
- Division of Pediatric Intensive Care, Department of Pediatrics, Bergmannsheil Pediatric Hospital Gelsenkirchen Buer, Gelsenkirchen, Germany
| | - Daniel Wüller
- Department of Pediatrics and Adolescent Medicine, Christophorus Hospital, Coesfeld, Germany
| | - Ursula Felderhoff-Müser
- Department of Pediatrics I (Neonatology, Pediatric Intensive Care, Pediatric Neurology, and Pediatric Infectious Diseases), University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Christian Dohna-Schwake
- Department of Pediatrics I (Neonatology, Pediatric Intensive Care, Pediatric Neurology, and Pediatric Infectious Diseases), University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Thiên-Trí Lâm
- German National Reference Laboratory for Meningococci and Haemophilus Influenzae, Institute for Hygiene and Microbiology, University of Würzburg, Würzburg, Germany
| | - Heike Claus
- German National Reference Laboratory for Meningococci and Haemophilus Influenzae, Institute for Hygiene and Microbiology, University of Würzburg, Würzburg, Germany
| | - Nora Bruns
- Department of Pediatrics I (Neonatology, Pediatric Intensive Care, Pediatric Neurology, and Pediatric Infectious Diseases), University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
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4
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Bertran M, D'Aeth JC, Abdullahi F, Eletu S, Andrews NJ, Ramsay ME, Litt DJ, Ladhani SN. Invasive pneumococcal disease 3 years after introduction of a reduced 1 + 1 infant 13-valent pneumococcal conjugate vaccine immunisation schedule in England: a prospective national observational surveillance study. THE LANCET. INFECTIOUS DISEASES 2024; 24:546-556. [PMID: 38310905 DOI: 10.1016/s1473-3099(23)00706-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 11/01/2023] [Accepted: 11/08/2023] [Indexed: 02/06/2024]
Abstract
BACKGROUND The UK transition from a 2 + 1 to a 1 + 1 infant immunisation schedule with the 13-valent pneumococcal conjugate vaccine (PCV13) on Jan 1, 2020, coincided with the start of the COVID-19 pandemic. We describe the epidemiology of invasive pneumococcal disease (IPD) in England over 6 financial years (April 1 to March 31) between 2017-18 and 2022-23. METHODS We used prospective national surveillance data, including serotyping and whole-genome sequencing of invasive isolates, to analyse IPD trends in England by age and financial year. We compared breakthrough infections and vaccine failure rates in 2022-23 among children eligible for the 1 + 1 schedule with rates in cohorts of children eligible for the 2 + 1 schedule between 2017-18 and 2019-20. We assessed genomic changes over time by comparing Global Pneumococcal Sequencing Clusters and multilocus sequence types among PCV13 serotypes causing IPD. FINDINGS There were 4598 laboratory-confirmed IPD cases in 2022-23, 3025 in 2021-22, 1240 in 2020-21, and 5316 in 2019-20. IPD incidence in 2022-23 was 14% lower than in 2019-20 (incidence rate ratio [IRR] 0·86, 95% CI 0·81-0·91; p<0·001). IPD incidence in 2022-23 compared with 2019-20 was 34% higher in children (aged <15 years) (378 cases vs 292 cases; IRR 1·34, 95% CI 1·08-1·68; p=0·009) and 17% lower in adults (aged 15 years and older; 4220 vs 5024; 0·83, 0·78-0·88; p<0·001). The proportion of PCV13-type IPD increased from 19·4% (95% CI 18·2-20·4; 957 of 4947) in 2019-20 to 29·7% (28·3-31·0; 1283 of 4326) in 2022-23, mainly due to serotype 3, but also serotypes 19F, 19A, and 4, alongside a decrease in non-PCV13 serotypes 8, 12F, and 9N. The increase in IPD incidence due to serotypes 3, 19A, and 19F was driven by clonal expansion of previously circulating strains, whereas serotype 4 expansion was driven by newer strains (ie, sequence types 801 and 15603). Breakthrough infections and vaccine failure rates were similar in children eligible for the 1 + 1 (1·08 per 100 000 person-years) and 2 + 1 (0·76 per 100 000 person-years; IRR 1·42, 95% CI 0·78-2·49; p=0·20) PCV13 schedules. INTERPRETATION Overall, IPD incidence in England was lower in 2022-23, 2 years after removal of pandemic restrictions, than in 2019-20. Breakthrough and vaccine failure rates were not significantly different between children who received the 1 + 1 compared with the 2 + 1 PCV13 immunisation schedule. The post-pandemic increase in childhood IPD incidence and especially PCV13-type IPD will require close monitoring. FUNDING None.
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Affiliation(s)
- Marta Bertran
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, London, UK
| | - Joshua C D'Aeth
- Respiratory and Vaccine Preventable Bacteria Reference Unit, UK Health Security Agency, London, UK
| | - Fariyo Abdullahi
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, London, UK
| | - Seyi Eletu
- Respiratory and Vaccine Preventable Bacteria Reference Unit, UK Health Security Agency, London, UK
| | - Nick J Andrews
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, London, UK
| | - Mary E Ramsay
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, London, UK; Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - David J Litt
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, London, UK; Respiratory and Vaccine Preventable Bacteria Reference Unit, UK Health Security Agency, London, UK
| | - Shamez N Ladhani
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, London, UK; Paediatric Infectious Diseases Research Group, St George's University of London, London, UK.
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